Is there any role of intravenous iron for the treatment of anemia in cancer?

Abstract

BackgroundAnemia is a major cause of morbidity in patients with cancer resulting in poor physical performance, prognosis and therapy outcome. The aim of this study is to assess the efficacy of intravenous (iv) iron administration for the correction of anemia, for the prevention of exacerbation of anemia, for decreasing blood transfusion rates, and for the survival of cancer patients.MethodsPatients with different solid tumor diagnosis who received iv iron during their cancer treatment were evaluated retrospectively. Sixty-three patients with hemoglobin (Hgb) levels between ≥ 9 g/dL, and ≤ 10 g/dL, and no urgent need for red blood cell transfusion were included in this retrospective analysis. The aim of cancer treatment was palliative for metastatic patients (36 out of 63), or adjuvant or curative for patients with localized disease (27 out of 63). All the patients received 100 mg of iron sucrose which was delivered intravenously in 100 mL of saline solution, infused within 30 min, 5 infusions every other day. Complete blood count, serum iron, and ferritin levels before and at every 1 to 3 months subsequently after iv iron administration were followed regularly.ResultsInitial mean serum Hgb, serum ferritin and serum iron levels were 9.33 g/dL, 156 ng/mL, and 35.9 μg/dL respectively. Mean Hgb, ferritin, and iron levels 1 to 3 months, and 6 to 12 months after iv iron administration were 10.4 g/dL, 11.2 g/dL, 298.6 ng/mL, 296.7 ng/mL, and 71.6 μg/dL, 67.7 μg/dL respectively with a statistically significant increase in the levels (p < 0.001). Nineteen patients (30 %) however had further decrease in Hgb levels despite iv iron administration, and blood transfusion was necessary in 18 of these 19 patients (28.5 %). The 1-year overall survival rates differed in metastatic cancer patients depending on their response to iv iron; 61.1 % in responders versus 35.3 % in non-responders, (p = 0.005), furthermore response to iv iron correlated with tumor response to cancer treatment, and this relation was statistically significant, (p < 0.001).ConclusionsIv iron administration in cancer patients undergoing active oncologic treatment is an effective and safe measure for correction of anemia, and prevention of worsening of anemia. Amelioration of anemia and increase in Hgb levels with iv iron administration in patients with disseminated cancer is associated with increased tumor response to oncologic treatment and overall survival. Response to iv iron may be both a prognostic and a predictive factor for response to cancer treatment and survival.

Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single‐institution retrospective analysis of 2163 Chinese patients

“…Indeed, there is a body of evidence indicating that blood transfusion contributes to increased risk of treatment‐related adverse events and postoperative complications , which provides the rationale for exploration of better treatment options. In addition, the efficacy of intravenous iron and recombinant human erythropoietin in anemic patients with GC is also worthy of further study . Therefore, large‐scale prospective studies are needed to validate whether early targeted intervention is beneficial to anemic patients undergoing curative resection for GC.…”

Iron in the Tumor Microenvironment—Connecting the Dots

“…However, data on effects of iron supplementation on tumor biology and long-term outcome of cancer patients are still scarce and a matter of serious concern. Until such data become available, a restrictive iron supplementation regimen is warranted for symptomatic patients with AOC but application thresholds for Hb and FT remain to be defined based on clinical data ( 133 , 134 ).…”

Role of intravenous iron in the treatment of anemia in patients with gastrointestinal tract tumors undergoing chemotherapy: a single-center, observational study

“…Although there are some concerns associated with intravenous iron administration, such as allergic reaction, iron accumulation in tissues, and scarce information about its efficacy and safety in the treatment of anemia in cancer patients, administration of intravenous iron is recommended by several guidelines. 7 , 11 , 14 FCM is currently marketed in Europe as Ferinject ® 50 mg iron/mL solution for injection/infusion and is indicated for the treatment of iron deficiency when oral iron preparations are ineffective or cannot be used. FCM has several advantages when compared with other iron formulations, such as better and more rapid hematologic response and better tolerability.…”

“… 15 In addition, FCM allows a better hematologic response and reduces the need of red blood cell transfusion in cancer patients, either in monotherapy or in combination with ESAs, and is also a cost-effective alternative for the treatment of anemia in these patients. 10 , 14 , 16 , 17 …”