Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron

Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron

Background: Chronic diseases reduce the availability of iron for effective erythropoiesis. This review summarises clinical consequences of iron deficiency (ID) and anaemia in cancer patients, mechanisms how impaired iron homeostasis affects diagnosis and treatment of ID, and data from clinical trials evaluating i.v. iron with or without concomitant erythropoiesis-stimulating agents (ESAs).......

Blogger's Note: table includes solid tumors

Table 1.

Reported prevalence of iron deficiency in different cancer patient populations

"potential role for i.v. iron as first-line therapy for CIA?

Guidelines recommend treatment of underlying causes of anaemia such as ID before initiation of an ESA. However, studies examining i.v. iron as sole anaemia treatment in cancer patients are only just starting to emerge. Two relevant small (N = 44 and 75 patients), controlled, randomised clinical trials have been published. Both studies involved patients with gynaecologic cancers receiving chemotherapy or radiochemotherapy, and in both, i.v. iron supplementation significantly reduced the number of required blood transfusions [15, 16]. In one study, significantly higher Hb levels were observed in the i.v. iron compared with the oral iron group at the end of the study period, although mean Hb levels included data from patients who received transfusions as well as those who did not [15]. The other study, comparing i.v. iron versus no anaemia treatment, achieved a lower rate in transfusions despite a higher baseline proportion of anaemic patients in the study group [16]. Both studies missed to assess iron status parameters such as TSAT and serum ferritin; thus, the proportion of patients with either functional or absolute ID could not be determined."

cross references:

1. 15.↵
   1. Dangsuwan P,
   2. Manchana T

   . Blood transfusion reduction with intravenous iron in gynecologic cancer patients receiving chemotherapy. Gynecol Oncol 2010;116:522-525.

   CrossRefMedline

   1. 16.↵
      1. Kim YT,
      2. Kim SW,
      3. Yoon BS,
      4. et al

      . Effect of intravenously administered iron sucrose on the prevention of anemia in the cervical cancer patients treated with concurrent chemoradiotherapy. Gynecol Oncol 2007;105:199-204.

      CrossRefMedline

       Concluding remarks

      The high prevalence of ID and anaemia in cancer patients suggests that these complications may need more attention in clinical practice. Current guidelines for treating anaemic cancer patients recommend that ID should be considered as underlying cause of anaemia before initiating ESA treatment and acknowledge that i.v. iron supplementation is superior to oral iron. .....................Published randomised controlled trials show that i.v. iron enhances response rates to ESA therapy and may be effective in reducing ESA doses and blood transfusion requirements, even if long-term safety remains to be examined. Available early reports on the use of i.v. iron as first-line anaemia therapy suggest that some patients could benefit from i.v. iron even without concomitant ESA. However, larger randomised controlled studies with long-term follow-up are necessary to confirm long-term efficacy and safety.

abstract: Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer

Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer

Conclusion: Managing chemotherapy-induced anemia with biosimilar epoetin α is consistently cost efficient over treatment with originator epoetin α, epoetin β, and darbepoetin α under both fixed and weight-based dosing scenarios.

Chemotherapy use and risk of bone marrow suppression in a large population-based cohort of older women with breast and ovarian cancer.

Med Oncol. 2010 Apr 2

Nurgalieva Z, Liu CC, Du XL.

Division of Epidemiology and Disease Control, University of Texas School of Public Health, 1200 Herman Pressler Drive, RAS-E631, Houston, TX, USA.

We studied 65,521 women with breast cancer and 7,420 women with ovarian cancer aged >/= 65 identified from the 16 areas of the Surveillance, Epidemiology and End Results program linked with Medicare data during 1991-2002. Bone marrow toxicity associated with chemotherapy was defined using diagnosis codes from Medicare inpatient, outpatient and physician claims. The time to event Cox regression was utilized to estimate the risk of bone marrow toxicity. Use of anthracyclines, taxanes or platinums was associated with increased risks of short- (3 months) anemia and neutropenia in patients with breast cancer. Alkylating agents or antimetabolites were additional significant predictors of anemia in women with ovarian cancer. Patients who received chemotherapy (irrespective of regimens) were twice (breast cancer) or three times (ovarian cancer) as likely to develop thrombocytopenia compared to those not receiving chemotherapy. Among women with breast cancer, patients receiving cyclophosphamide, methotrexate and fluorouracil regimens (hazard ratio = 19.0, 95% CI = 11.2-32.5), platinum/taxane therapy (21.9, 11.9-40.4) or the cyclophosphamide, adriamycin and fluorouracil regimen (32.5, 19.6-53.9) were strongly associated with risk of aplastic anemia. There was a dose-response relationship between the use of taxane or platinum and the risk of bone marrow suppression, whereas the increased risk of bone marrow toxicity was consistently higher in those with use of alkylating agents or anthracycline-based regimens irrespective of the increasing number of cycles received. In conclusion, there was an association between chemotherapy use and clinical manifestations of bone marrow toxicities in a population-based setting.

ACS :: Possible Risks of Blood Product Transfusions

Comment: Before Erythropoiesis-stimulating agents were introduced, blood transfusions were widely used for the improvement of platelet counts etc. With recent negative research regarding Erythropoiesis-stimulating agents, blood transfusions will be a choice - seek professional/oncologist opinion. This article from the ACS describes some of the concerns with blood transfusions.