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

• Published in: Annals of oncology Vol. 23; no. 8; pp. 1954 - 1962
• Main Authors: Aapro, M., Österborg, A., Gascón, P., Ludwig, H., Beguin, Y.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2012; Oxford University Press
• Subjects: anaemia; Anemia, Iron-Deficiency - blood; Anemia, Iron-Deficiency - etiology; Anemia, Iron-Deficiency - therapy; Anemias. Hemoglobinopathies; Antineoplastic agents; Biological and medical sciences; chemotherapy-induced anaemia; Clinical Trials as Topic; diagnosis; Diseases of red blood cells; Hematologic and hematopoietic diseases; hepcidin; Humans; intravenous iron; Iron Compounds - administration & dosage; iron deficiency; Medical sciences; Medicin och hälsovetenskap; Metabolic diseases; Metals (hemochromatosis...); Neoplasms - blood; Neoplasms - complications; Other metabolic disorders; Pharmacology. Drug treatments; Prevalence; intravenous iron; diagnosis; hepcidin; anaemia; iron deficiency; chemotherapy-induced anaemia; Prevalence; Intravenous administration; Iron deficiency anemia; Metabolic diseases; Hemopathy; Iron; Management; Malignant tumor; Inorganic element; Epidemiology; Chemotherapy; Treatment; Clinical management; Diagnosis; Sideropenia; Hepcidin; Cancer
• ISSN: 0923-7534; 1569-8041; 1569-8041
• DOI: 10.1093/annonc/mds112

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). Clinical trial reports were identified in PubMed and abstracts at relevant major congresses. Reported prevalence of ID in cancer patients ranges from 32 to 60% and most iron-deficient patients are also anaemic. Randomised clinical trials have shown superior efficacy of i.v. iron over oral or no iron in reducing blood transfusions, increasing haemoglobin, and improving quality of life in ESA-treated anaemic cancer patients. Furthermore, i.v. iron without additional ESA should be evaluated as potential treatment in patients with chemotherapy-induced anaemia. At recommended doses, i.v. iron is well tolerated, particularly compared with oral iron. No serious drug-related adverse effects were seen during long-term use in renal disease and no effect on tumour growth has been observed in trials with anaemic cancer patients. Reliable diagnosis and treatment of ID are recommended key steps in modern cancer patient management to minimise impact on quality of life and performance status.