06/28/2017

NCCN has published updates to the NCCN Guidelines® and NCCN Compendium® for Cancer- and Chemotherapy-Induced Anemia

NCCN has published updates to the NCCN Guidelines^® and NCCN Drugs & Biologics Compendium (NCCN Compendium^®) for Cancer- and Chemotherapy-Induced Anemia. These NCCN Guidelines are currently available as Version 1.2018. 

• Details and recommendations relating to the Erythropoiesis-Stimulating Agents (ESAs) Risk Evaluation and Mitigation Strategy (REMS) and ESA APPRISE (Assisting Providers and cancer Patients with Risk Information for the Safe use of ESAs) Oncology Programs have been removed from the guidelines, based on the FDA release of REMS requirements for ESAs.
  
  
• Special Categories in Considering ESA Use (ANEM-4)
  • “Clinical trial” has been added as an option for consideration based on patient preference for those undergoing palliative treatment.
  • The following option has been revised where recommended: "Consider ESAs by FDA dosing/dosing adjustments under REMS guidelines, with informed consent of patient."

• Indications for Red Blood Cell Transfusion in Patients (ANEM-A)
  • The following bullet has been removed: "Anemia in setting of acute coronary syndromes or acute myocardial infarction: Transfusion goal is unclear and is being evaluated. Consider clinical context and published guidelines."

• Parenteral Iron Preparations (ANEM-C, 2 of 3)
  • Low-molecular weight iron dextran: The following administration recommendations have been added for total dose infusion: "Calculated total iron dextran dose in 500 mL of 0.9% NaCl solution administered at 175 mL/h.
    • Reference: Auerbach M, Ballard H, Trout JR, et al. Intravenous iron optimizes the response to recombinant human erythropoietin in cancer patients with chemotherapy-related anemia: A multicenter, open-label, randomized trial. Journal of Clinical Oncology 2004;22:1301-1307.

• Management of Cancer- and Chemotherapy-Induced Anemia for Patients Who Refuse Blood Transfusions (ANEM-D)
  • The following bullet has been removed: "In addition, prior approval from third-party payers should be sought to prevent increasing the financial burden of the patient."