Erythropoietins – Epoetin alfa, beta, zeta, theta and Darbepoetin alfa
Erythropoietin is a treatment for anaemia due to cancer or its treatment. This information describes erythropoietin, how it is given and some of its possible side effects. It should ideally be read with our general information about your type of cancer.
What is erythropoietin?
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Erythropoietin is a special type of protein called a growth factor. It stimulates the bone marrow to make red blood cells. The bone marrow is a spongy material inside the bones where all of our blood cells are made.
Erythropoietin is made naturally in the body. It can also be made outside the body and used as a treatment for anaemia. Anaemia means having too few red blood cells.
Erythropoietins used to treat anaemia are sometimes called epoetins.
There are four different types of epoetin:
epoetin alfa (Binocrit®, Eprex®)
epoetin beta (NeoRecormon®)
epoetin zeta (Retacrit®)
epoetin theta (Eporatio®).
Darbepoetin alfa (Aranesp®) is a longer acting form of epoetin, which can be given less frequently.
Why erythropoietin is given
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Many people with cancer will develop anaemia at some time during their illness. This can be due to the cancer or its treatment, including chemotherapy. If the number of red blood cells in your blood is low, you may become very tired and feel that you have no energy. You may also become breathless. These symptoms occur because the red blood cells contain haemoglobin (Hb), which carries oxygen around the body.
A blood transfusion is the most commonly used treatment for anaemia caused by cancer treatment but, in some situations, erythropoietin may be given as an alternative to a blood transfusion.
When erythropoietin is used
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The National Institute for Health and Clinical Excellence (NICE) gives advice on which new treatments should be available on the NHS in England and Wales. NICE has approved erythropoietin as a possible treatment for anaemia in some women with ovarian cancer who are having treatment with platinum-based chemotherapy such as carboplatin or cisplatin.
NICE has also approved erythropoietin for use in people with other types of cancer who have severe anaemia due to cancer treatment, but can't be given blood transfusions.
The Scottish Medicines Consortium (SMC) gives advice about new treatments on the NHS in Scotland. The SMC has also recommended the use of erythropoietin in certain situations.
What erythropoietin looks like
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Erythropoietin is a colourless fluid in a small glass bottle or a pre-filled syringe.
How erythropoietin is given
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Erythropoietin is usually given by an injection under the skin (subcutaneously), most often in the thigh or abdomen. You, or a person caring for you, can be taught how to give the injections so that you can continue the treatment at home. Alternatively you may be given the injections by a district nurse or GP practice nurse.
In some situations, taking iron supplements may make erythropoietin more effective so you may be given iron tablets or injections during your treatment. Your doctor can tell you if this will be helpful for you.
How often you have erythropoietin will depend on the type used and on advice from your doctor. It can be given three times a week, once a week or every three weeks. The injections usually continue until one month after your chemotherapy course has finished, or until you are no longer anaemic.
Possible side effects of erythropoietin
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When you're given erythropoietin injections the amount of erythropoietin in your body becomes much higher than normal. This is why you may have side effects, even though erythropoietin is a naturally occurring substance. However, these side effects aren't usually severe and they do lessen after erythropoietin treatment ends.
Each person’s reaction to treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having erythropoietin treatment.
We've outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
Some people have flu-like symptoms, such as feeling sick, joint pains, weakness, dizziness and tiredness. These are more likely to occur at the start of your treatment. Your doctor may prescribe a painkiller, such as paracetamol, to help with these symptoms.
Some people find that erythropoietin causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
High blood pressure
Your doctor will closely monitor your blood pressure while you're receiving erythropoietin. Let your doctor know if you take medication for high blood pressure.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and erythropoietin may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most blood clots can be treated with drugs that thin the blood. Your doctor or nurse can give you more information.
Skin irritation at the injection site
Your skin may become red or tender in the area the injection is given. Having the injection in a different place on your body each time may help.
You may develop a skin rash, which may be itchy.
It's important to let your doctor know straight away if you feel unwell or have any severe side effect, even if they're not mentioned above.
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A number of trials have looked at the benefits of using erythropoietin in the treatment of people with different types of cancer. The results from some of these trials have raised questions about its safety and have suggested that sometimes erythropoietin may cause the cancer to grow in size. These results are being reviewed by the drug safety authorities.
Although some people with cancer will benefit from having erythropoietin, its benefits and risks should be carefully considered for each individual person.
If you have any questions about this, it's important to talk them over with your doctor.
Erythropoietin should be stored in the fridge and protected from light. Portable fridges can be bought from camping shops to store the erythropoietin if you're away from home. Follow any storage instructions given by your pharmacist.
Erythropoietin doesn’t usually react with other medicines, but you should tell your doctor if you are taking medicines to suppress your immune system, such as ciclosporin.
You should also tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while having erythropoietin as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether erythropoietin can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that erythropoietin drugs may be present in breast milk, so women are advised not to breastfeed during treatment and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having erythropoietin treatment. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This information has been compiled using information from a number of reliable sources including:
British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Erythropoetin (alpha and beta) and darbepoetin for the treatment of cancer-treatment induced anaemia (TA142). National Institute for Health and Clinical Excellence (NICE), May 2008.
620/10 - Epoetin theta (Eporatio), Scottish Medicines Consortium (SMC), July 2010.
Thank you to Christine Clarke, Network Lead Pharmacist, and all of the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.