This work was conducted to evaluate the effect of early intervention with epoetin alfa (EPO) on transfusion requirements, hemoglobin level (Hb), quality of life (QOL) and to explore a possible relationship between the use of EPO and survival, in patients with solid tumors receiving platinum-based chemotherapy. Three hundred and sixteen patients with Hb⩽12.1g/dL were randomised 2:1 to EPO 10000 IU thrice weekly subcutaneously (n=211) or best supportive care (BSC) (n=105). The primary end point was proportion of patients transfused while secondary end points were changes in Hb and QOL. The protocol was amended before the first patient was recruited to also prospectively collect survival data. EPO therapy significantly decreased transfusion requirements (P<0.001) and increased Hb (P<0.005). EPO-treated patients had significantly improved QOL compared with BSC patients (P<0.05). Kaplan–Meier estimates showed no differences in 12-month survival (P=0.39), despite a significantly greater number of patients with metastatic disease in the EPO group (78% vs. 61%, P=0.001). EPO was well tolerated. This study has shown that early intervention with EPO can result in a significant reduction of transfusion requirements and increases in Hb and QOL in patients with mild anemia during platinum-based chemotherapy.