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RAYMOND J. MULLER, M.S., B.S.PHARM., FASHP, is Associate Director, Division of Pharmacy Services, Memorial Sloan-Kettering Cancer Center, New York, NY, and Affiliated Clinical Professor, St. John’s University College of Pharmacy and Allied Health Professions, Jamaica, NY. DAVID BARIBEAULT, B.S.PHARM., BCOP, is Clinical Coordinator—Hematology/Oncology, and Director, Hematology/Oncology Residency Program, Boston Medical Center, Boston, MA.

Address correspondence to Mr. Muller at the Division of Pharmacy Services, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room S-706, New York, NY 10021.

Purpose. The safety and efficacy of extended-dosage-interval regimens of erythropoiesis-stimulating agents (ESAs) for managing chemotherapy-induced anemia (CIA) are reviewed. Summary. Anemia is a frequent complication of chemotherapy. The ESAs epoetin alfa and darbepoetin alfa have been shown to safely and effectively manage CIA; comparable outcomes have been demonstrated between epoetin alfa 40,000 units once weekly and darbepoetin alfa 200 µg every two weeks. These commonly prescribed regimens necessitate extra clinic visits by cancer patients receiving cyclic chemotherapy. ESA administration can now often be synchronized with a three-week chemotherapy cycle because of the recent approval of darbepoetin alfa 500 µg every three weeks for CIA. However, in the Phase III trial providing the basis for this new dosage recommendation, more than 70% of patients required a 40% reduction in the dosage, resulting in an average dose of 375 µg every three weeks. The extended-dosage-interval regimens have not been associated with an increase in cardiovascular or thrombotic adverse events. Extended-dosage-interval regimens of epoetin alfa are under investigation and may provide additional alternatives. Synchronizing ESA therapy with scheduled chemotherapy visits would help minimize disruptions for patients and caregivers and improve the use of health care resources. Conclusion. Administration of darbe -poetin alfa every three weeks offers the convenience of synchronization of treatment with 21-day-cycle chemotherapy in many patients with CIA. Extended-dosage-interval regimens for epoetin alfa are being investigated and show promise. Index terms: Anemia; Antineoplastic agents; Darbepoetin alfa; Dosage schedules; Epoetin alfa; Hematopoietic agents; Toxicity