IV iron in cancer patients with iron deificiency on chemotherapy – pro
In the 2010 ASH annual meeting, two meta-analyses evaluating the use of intravenous iron supplementation in the treatment of chemotherapy-induced anemia were presented.[63,64] In both of these abstracts, the total number of patients who participated in the trials included in the analyses exceeded 1600. ESAs were administered in most of the studies. Treatment with intravenous iron significantly increased the number of patients achieving a hematopoietic response and significantly reduced the number of patients who required blood cell transfusions, with no increase in the incidence of adverse events or mortality. The benefit of intravenous iron was independent of the type of ESA used.
Therefore, in all cancer patients with any degree of anemia, it is important to investigate whether there is iron deficiency. If the parameters indicate low levels of ferritin, or low Percent Saturation iron supplementation is indicated, preferably through parenteral administration. Such treatment could also be considered in patients who will start treatment with an ESA, due to the improved responses in terms of hemoglobin levels resulting from the combined treatment. At present, there appears to be enough scientific support for the use of intravenous iron supplementation to improve hemoglobin responses in anemic patients with cancer, and this has been included in various guidelines. Nevertheless, prospective studies on the long-term efficacy and safety of intravenous iron are warranted. Moreover, recommendations for the optimal formulation, doses, and treatment schemes of iron supplementation concurrently with ESA treatment in cancer-related anemia are awaiting data from prospective, randomized trials.
Ferreiro-Iglesias R, Barreiro-de-Acosta M, Seijo-Ríos S, Lorenzo A, Domínguez-Muñoz JE.
Efficacy of intravenous iron in treating iron deficiency anaemia in patients with inflammatory bowel disease. Are there predictors of response? [Article in English, Spanish]Rev Esp Enferm Dig. 2011 May;103(5):245-9.
H.Tilman Steinmetz The role of intravenous iron in the treatment of anemia in cancer patients. Ther Adv Hematol. 2012 Jun; 3(3): 177191