[Updating 1999 of Standards, Options and Recommendations (SOR) for the clinical use of erythropoietin in oncology. FEDERATION OF THE FRENCH CANCER CENTRES (FNCLCC)].

CONTEXT

The <<Standards, Options and Recommendations>> (SOR), started in 1993, are a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. The initial guidelines are being updated in case of new evidence.

OBJECTIVES

To update the clinical practice guideline [39] with definitions of new Standards, Options and Recommendations for the use of recombinant human erythropoietin (rHuEPO) in oncology.

METHODS

Data have been identified by literature search using Medline, Current Contents, Embase, Cancerlit (march 1996-march 1999). The main end points considered were hemoglobin level, haematocrit, quality of life, transfusion requirements, incidence and length of hospital stays, efficacy of cancer treatment, safety and costs. Once the guideline was updated and defined, the document was submitted to 42 reviewers for peer review, and to the medical committees of the 20 French Cancer Centres for review and agreement.

RESULTS

The new key recommendations are: 1) The use of recombinant human erythropoietin in oncology is an alternative to treat chemotherapy-induced anemia when the chemotherapeutic regimen contains platinum; 2) Cancer-induced anemia reduces patients' quality of life. Treatment of anemia by transfusions of erythropoietin may improve quality of life; 3) We recommend assessment of haemoglobin levels during radiation therapy and the possible use of erythropoietin to optimise the efficacy of radiation therapy; 4) Erythropoietin is effective in others pathologies (multiple myeloma, non-Hodgkin lymphoma, non-platinum based chemotherapy.) and also in pediatric patients but the risk/benefit ratio for anemia therapy (i.e. transfusion or erythropoietin therapy) must be analysed for each individual; 5) We recommend an economic analysis of the need of erythropoietin within the context of the french health care system.