A final analysis from the CHOICE study examining darbepoetin alfa use for chemotherapy-induced anaemia in current European clinical practice

Objectives: The CHOICE study was a prospective, multicentre, observational study designed to assess the level of adherence in current clinical practice to the European product label and the EORTC guidelines for the treatment of chemotherapy-induced anaemia with darbepoetin alfa (DA). Methods: Hb levels and red blood cell (RBC) transfusion requirements were evaluated among 1900 patients with solid tumours in 11 European countries. The primary outcome measure was the proportion of patients with a target Hb level of ≥10≤12g/dL after 9 weeks' DA treatment. Results: The full analysis set (FAS) comprised 1887 patients (mean±SD age 62.4±11.4 years) divided into categories by baseline Hb<9g/dL (n=281); 9<10g/dL (n=770); 10<11g/dL (n=695); ≥11g/dL (n=114). The proportion of patients who remained on the study at week 9 achieving the target Hb level was 37 (n=60), 48 (n=217), 54 (n=210) and 38 (n=23) in the subgroups with a baseline Hb level of <9g/dL, 9<10g/dL, 10<11g/dL and ≥11g/dL, respectively. In the <9g/dL, 9<10g/dL, 10<11g/dL and ≥11g/dL subgroups of the FAS, the number of patients maintaining Hb levels ≥10g/dL after their first achievement of an Hb value of 10g/dL was 95 (34), 372 (48), 476 (68) and 87 (76), respectively. The KaplanMeier percentages of patients who required an RBC transfusion from week 5 until end of treatment period were: 29, 20, 12 and 17 in the <9g/dL, 9<10g/dL, 10<11g/dL and ≥11g/dL subgroups, respectively. KaplanMeier percentages of patients reaching an Hb level of >13g/dL were 10, 9, 21 and 29, respectively. Potential bias could not be excluded due to the study's observational nature. Conclusions: DA initiation and target Hb ranges adhered to current guidelines in the majority of patients. Furthermore, this study demonstrates faster achievement of the target range and reduced transfusion requirements are associated with initiation of DA at Hb levels of 9<10g/dL and 10<11g/dL rather than <9g/dL.

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