FDA was recently notified of the results of a 989 patient, multicenter, double-blind, randomized, placebo-controlled study of Aranesp (darbepoetin alfa, Amgen, Thousand Oaks, CA) in anemic cancer patients not receiving concurrent cytotoxic therapy. The study results demonstrated an increased mortality in patients receiving Aranesp compared to those receiving placebo (hazard ratio 1.25; 95% confidence interval: 1.04, 1.51). In addition, Aranesp did not reduce red blood cell transfusion requirements in these patients. The target hemoglobin in the Aranesp treatment group was 12 g/dl. The findings in this study may be applicable to other erythropoiesis-stimulating agents (ESA). Additional information on this study is in Amgen’s letter posted on FDA’s MedWatch website.
FDA also directs prescriber’s attention to the interim results of the Danish Head and Neck Cancer Study Group trial (DAHANCA 10) comparing radiation therapy alone to radiation therapy plus Aranesp in the treatment of advanced head and neck cancer. The data monitoring committee (DMC) recommended the trial’s termination. This open-label, randomized trial was designed to test the hypothesis that use of Aranesp to maintain a hemoglobin of 14.0-15.5 g/dL during radiotherapy would result in superior loco-regional disease control. The DMC reported an approximate 10% difference in 3-year loco-regional control (p=0.01) in favor of the control group. A statistically non-significant difference in overall survival (p=0.08) also favoring the control arm was observed. These results are consistent with findings by Henke et al that are described in the approved product labeling (under Precautions, Tumor Growth Factor Potential) and were presented at a May 4, 2004 Oncologic Drugs Advisory Committee (ODAC) meeting
FDA has previously noted that increased mortality, possible tumor promotion and thromboembolic events have been observed in patients receiving ESAs when dosing has targeted hemoglobin levels >12 gm/dL. The recommended labeled target hemoglobin in current product labeling is 12 gm/dl. Please refer to the above 2004 ODAC transcript for further discussion.
FDA is planning to review and discuss the safety and efficacy of ESAs at an upcoming meeting of the ODAC.
Aranesp was approved in July, 2002 for the treatment of anemia in patients with non-myeloid malignancies where anemia is attributed to the effects of concomitantly administered chemotherapy. Full prescribing information for Aranesp, including clinical trial information, safety, dosing, drug-drug interactions, and contraindications is available in: Drugs@FDA A revised FDA Healthcare Professional Sheet regarding evolving safety issues with ESAs is posted.
Healthcare professionals should report all serious adverse events suspected to be associated with the use of any medicine and device to FDA’s MedWatch Reporting System by completing a form online at by faxing (1-800-FDA-0178) or mailing the postage-paid address form provided online, or by telephone (1-800-FDA-1088).
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