Erythropoietin

Some cancers and cancer treatments can affect the bone marrow, reducing your ability to make new red blood cells. This condition is called anaemia, and can make you feel tired, breathless or weak.

To help restore the number of red blood cells in your blood, your doctor may prescribe a treatment called erythropoietin. This is a protein that helps your bone marrow to make more red blood cells. Erythropoietin is only used in certain situations. Having a blood transfusion is a much more common treatment for anaemia.

Erythropoietin is given as an injection under the skin. You or your carers can be taught how to give the injections so you can have the treatment at home.

It can have some side effects, but they usually are not severe and won’t affect everyone having the treatment. Your doctor will discuss with you whether erythropoietin is a suitable treatment for you.

What is erythropoietin?

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

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

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 it looks like

Erythropoietin is a colourless fluid in a small glass bottle or a pre-filled syringe.


How erythropoietin is given

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

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.

Flu-like symptoms

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.

Headaches

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.

Skin rash

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.


Additional information

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.

Storing erythropoietin

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.

Other medicines

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.

Contraception

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.

Breastfeeding

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.

Non-cancer admission

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.

Emergency contacts

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.


Back to Supportive therapies

Blood transfusions

Some cancers or cancer treatments can cause anaemia, which is a low number of red blood cells. Blood transfusions are used to treat anaemia.

G-CSF

Having chemotherapy can make you more prone to infections. G-CSF helps you make more white blood cells to reduce that risk.

Nephrostomy

A nephrostomy is a tube that drains urine from the kidney if there is a blockage in your urinary system.

Plasma exchange

Plasma exchange (sometimes called plasmapheresis) is a supportive treatment used for myeloma and a rare type of lymphoma called Waldenström's macroglobulinaemia.

Platelet transfusions

Platelets are cells that help to stop bleeding. Some cancers or cancer treatments can lead to low platelets and you may need a platelet transfusion.

Steroids

Steroids can be used as part of cancer treatment or to help with the side effects of treatment.