Chemo, Anemia, and Aranesp

Following up on my post of last week, Whining About Anemia, I've gathered some more info on the drugs used to boost low red-cell counts in cancer patients, which include Aranesp, Epogen, and Procrit (all brand names).

I've gotten Aranesp and Procrit at different times, and never thought much about it. Nor did anyone on my medical team mention any risks or problems associated with the shot. So I was more than a bit surprised, and dismayed, to read that some people had apparently DIED as a result of getting these drugs.

A reader of my blog, Mike, who gets Aranesp, wrote and explained his understanding of the situation, which was exactly the same as my oncologist's later explanation (good job, Mike!), and he also sent me a copy of the FDA warning.

Basically, problems are more likely to arise when these drugs are used to take the patient to too high a hemoglobin level. The magic number seems to be 12 g/dL. Also, patients' blood pressure needs to be monitored carefully.

What kind of "problems," you ask? Death. Myocardial infarction. Hospitalization for congestive heart failure. Stroke. Serious stuff.

This is what the FDA says about patients: 
Physicians and other health-care professionals should discuss the following with their patients:


• The goal of treatment with erythropoiesis stimulating agents (ESA) is to increase the number of red blood cells which can help them in treating their anemia.

• Treatment with an ESA can be harmful if not closely monitored.

• The importance of keeping their appointments for their blood tests.

• The need to monitor their blood pressure every day (if appropriate) and call the doctor if there are any changes outside of the range established for the patient.

• To call the doctor if they experience any of the following symptoms:

 o Pain and/or swelling in the legs

 o Worsening in shortness of breath

 o Increases in blood pressure

 o Dizziness or loss of consciousness

 o Extreme tiredness

 o Blood clots in hemodialysis vascular access ports.

We'll all make our own decisions, of course, but for now, I'm piling on the spinach. And taking my iron tonic, even though it tastes like dead weeds.

I guess what dismays me is that I had gotten a shot of Aranesp in December, and no one discussed any problems or risks with me then, nor did my doctor monitor my hemoglobin or my blood pressure closely, both FDA recommendations for patients on these drugs.

Here's the latest report I could find on Aranesp, which says that the FDA is going to require stronger warning labels on these drugs:

FDA warns on Amgen, J&J anemia drugs

@ Jeanne Sather 2007.