Treatment of anemia in cancer patients undergoing chemotherapy with intravenous ferric carboxymaltose without erythropoiesis-stimulating agents

Abstract

Background: Anemia is commonly encountered in cancer patients receiving active chemotherapy. Due to adverse events and presumed negative effects on disease-progression and survival, erythropoiesis-stimulating agents are not frequently used. In this study, we assess the efficacy and safety of intravenous ferric carboxymaltose (FCM) to treat cancer-induced anemia (CIA). Patients and Methods: We recruited adult cancer patients on active chemotherapy with a hemoglobin (Hb) level ⩽11.0 g/dL. Based on serum ferritin (sFr) and transferrin saturation (TSAT), patients were divided into 3 groups: group I (absolute iron deficiency, n = 26) with sFr < 30 ng/mL and TSAT < 20%; group II (functional iron deficiency, n = 24) with sFr 30–800 ng/mL and TSAT < 20%; and patients with TSAT ⩾ 20% were placed in group III as “others” ( n = 34). All patients were treated with intravenous FCM. Serum hepcidin and C-reactive protein were used as biomarkers to predict response. Results: A total of 84 patients with a median age (SD) of 53.8 (10.6) were recruited. Baseline median Hb level was 10.2 (range: 8.3–11.0) gm/dL. At week 12, there was a significant increment in Hb level for patients in groups I and II (median increment: 2.35 and 1.5 gm/dL, respectively), with limited response observed in group III, and most of the increment noted as early as week 3 (⩾1.0 g/dL). Responders tended to have lower levels of hepcidin. No clinically significant adverse events were reported; however, asymptomatic hypophosphatemia was observed in 39 (46.4%) patients. Conclusions: Intravenous FCM is a safe and effective treatment option for the management of a subgroup of patients with CIA. The study was registered at ClinicalTrials.gov [Identifier: NCT04246021]

Seven-Year Single-Center Experience of the Efficacy and Safety of Ferric Carboxymaltose in Cancer Patients with Iron-Deficiency Anemia

“…The overall treatment response rate was 59.5%, while a difference was noted between the absolute and functional iron deficiency groups (80.8% vs. 70.8%). Although the results of the study indicate that the effectiveness may be lower in patients with functional iron-deficiency anemia, treatment success is still high in both groups and consistent with our findings [24].…”

Efficacy of ferric carboxymaltose or darbepoetin alfa for chemotherapy-induced anemia in patients with esophagogastric or pancreaticobiliary cancer: a retrospective comparative study

“… 17 , 18 , 29 However, recent several studies have assessed the efficacy of IV iron as a monotherapy for CIA; these studies have consistently demonstrated increases in Hb levels and/or notable reductions in transfusion rates. 19 , 20 , 30 – 33 One example is the IRON-CLAD study, which showed that IV iron supplementation, specifically in the form of FCM monotherapy, allowed most patients receiving chemotherapy to maintain Hb levels within 0.5 g/dL of baseline, and was significantly more effective in doing so when compared with a placebo. 30 The PROFOUND trial, demonstrated that iron isomaltoside and oral iron produced comparable sustained increases in Hb concentration.…”

“…Several previous studies have defined it as a Hb increase of ⩾2.0 g/dL or Hb of ⩾12.0 g/dL, 17 , 18 whereas recent studies have defined it as a Hb increase of ⩾1.0 g/dL or Hb of ⩾11.0 g/dL. 19 , 20 In the present study, Hb response was defined as a Hb increase of ⩾1.0 g/dL or a Hb of ⩾11.0 g/dL within 3 months following CIA treatment without an RBC transfusion. The proportion of patients receiving a PRC transfusion within 6 months of the baseline and the time to PRC transfusion were also analyzed.…”

Anemia in patients receiving anticancer treatments: focus on novel therapeutic approaches

“…The same meta-analysis also reported the efficacy of IV iron alone, while only a few smaller trials were available at that time (44). Indeed, with the recent advent of modern third-generation IV iron preparations (45), evidence is accumulating on the efficacy of iron monotherapy in CCRA (46)(47)(48)(49). CCRA patients with concomitant AID are the most suitable candidates for this approach, but diagnosing AID in cancer patients using traditional iron biomarkers is challenging (6), due, for example, to ferritin upregulation by tumor necrosis factor-alpha (TNF-a) and pro-inflammatory cytokines (50,51).…”