- Class: Erythropoiesis-stimulating agent (ESA)Type: Recombinant human erythropoietin (glycoprotein)
- Route: Subcutaneous (SC) or intravenous (IV) injection
Mechanism of Action (MOA)
- Binds to erythropoietin receptors on erythroid progenitor cells in the bone marrow
- Stimulates proliferation, differentiation, and maturation of red blood cells
- Increases hemoglobin and hematocrit → improves oxygen-carrying capacity
Clinical Uses
- Chemotherapy-induced anemia in cancer patients (non-myeloid malignancies)
- Chronic kidney disease (CKD)-related anemia (non-oncology)
- Preoperative anemia in select patients (off-label in oncology)
Dosing (Adults, Oncology)
- IV or SC: 150 IU/kg 3 times per week or 40,000 IU once weekly
- Adjust dose based on hemoglobin response, typically every 4 weeks
- Target hemoglobin: ≤120 g/L to reduce thromboembolic risk
- Discontinue or reduce dose if hemoglobin rises >120 g/L
Toxicities
- Cardiovascular: hypertension, increased risk of thromboembolic events (DVT, PE, stroke, MI)
- Hematologic: rare pure red cell aplasia (antibody-mediated)
- Headache, fatigue
- Injection site reactions (pain, redness)
- Rare: seizure or allergic reaction
Monitoring
- Hemoglobin and hematocrit every 1–2 weeks initially, then every 2–4 weeks
- Blood pressure
- Iron status: iron, ferritin, transferrin saturation – ESA therapy often requires adequate iron
- Monitor for signs of thrombosis
- Adjust dose or hold therapy if hemoglobin >120 g/L
Summary
Epoetin alfa (Epogen®, Procrit®) is an ESA used to treat chemotherapy-induced anemia. Key concerns are thromboembolic risk, hypertension, iron deficiency, and hemoglobin overshoot, requiring regular monitoring of hemoglobin, iron status, and blood pressure.