Intravenous iron improves treatment response in chemotherapy and cancer-related anaemia

For patients with chemotherapy-induced anaemia, adding intravenous iron to treatment with the drug darbepoetin alfa results in a faster and more potent improvement in response with lower doses of the drug, according to data presented at the 33rd Congress of the European Society for Medical Oncology in Stockholm.

Anaemia is a common problem in cancer patients, caused by a combination of factors including the malignancy itself, plus the effects of chemotherapy. Treatments can include erythropoiesis-stimulating drugs (ESAs) such as darbepoetin alfa, which stimulates the production of new blood cells, although up to one in three patients do not respond to these therapies.

Dr. Michael Auerbach, a haematologist from Baltimore, Maryland, USA, and colleagues studied whether adding intravenous iron would improve response rate in a group of 238 patients with a range of cancer types. The researchers divided the patients into four groups: either high-dose darbepoetin alfa plus or minus iron, or low-dose darbepoetin alfa plus or minus iron.

“In a large subset of patients with cancer-related anemia, an important factor that limits their response to treatment is the presence of an iron deficiency,” Dr. Auerbach said.

The results of the 18-week trial showed that adding intravenous iron, administered every three weeks, improved the likelihood that patients achieved the target for hemoglobin levels, and reduced the length of time it took to see an improvement in the production of red blood cells, Dr. Auerbach reported. The results held true for either dose of darbepoetin alfa.

Other studies have shown that adding intravenous iron can have a similar impact with other erythropoiesis drugs, he noted. “This is the sixth of six studies to show it. They all decreased the need for erythropoiesis stimulating agents--for the same benefit with huge cost savings and probable decreased toxicity.”

Dr Auerbach insisted that it was a safe procedure with the number of serious adverse events (SAE) below 1 in 200,000. He also pointed out that it was already used regularly by kidney specialists and would allow oncologists to save large amounts of money by more effective use of ESAs and blood transfusions:

“It is my opinion that both erythropoiesis-stimulating agents and the western blood supply will be rescued once oncologists embrace the routine use of this clearly effective, routinely safe, and inexpensive technology”.

More from Dr. Michael Auerbach here.

Video of his talk at ESMO here.