Supplemental iron improves treatment response in chemotherapy-induced anemia

STOCKHOLM (Reuters Health) - Intravenous (IV) iron strengthens and accelerates the response to the erythypoiesis-stimulating agent darbepoetin alfa in patients with chemotherapy-induced anemia (CIA), researchers announced here at the 33rd Congress of the European Society for Medical Oncology (ESMO).

About 20% to 30% of patients with CIA do not respond to erythypoiesis-stimulating agents because of functional or absolute iron deficiency.

Dr. Michael Auerbach, in private practice with Auerbach Hematology Associates in Baltimore, Maryland, and a clinical professor of medicine at Georgetown University in Washington DC, and colleagues randomized 238 patients to a fixed dose of darbepoetin 300 mcg or 500 mcg every 3 weeks with or without 400 mg IV iron dextran.

Participants in the trial had a non-myeloid malignancy, CIA defined as hemoglobin levels of 10 g/dL or less, at least eight additional weeks of chemotherapy, and no baseline iron or B12/folate deficiency. Darbepoetin was withheld when the patient's hemoglobin exceeded 13 g/dL, but the IV iron was given to total dose according to protocol.

The primary endpoint was the percentage of patients achieving a hemoglobin level of 11 g/dL or more at 15 weeks.

Since the IV iron improved response similarly to both doses of darbepoetin, the data in the iron groups were pooled.

Overall, 72 % of patients in the no-iron group and 82% of patients in the iron group achieved the primary endpoint. The median number of weeks required to achieve target was 10 weeks versus 8 weeks, respectively.

A hematopoietic response was defined as 2 g/dL hemoglobin increase or the attainment of 12 g/dL or more hemoglobin from baseline to end of the treatment period.

The hematopoietic response was 63% in the no-iron group and 82% in the iron group. "This finding is consistent with results from five previously published studies with no contradictory data," Dr. Auerbach commented.

The need for transfusions did not differ significantly between the iron and no-iron group; however, this study was not powered to detect a difference.

Dr. Auerbach said that the routine use of IV iron in his practice results in a saving of $1301 per patient per 12-week period. "If we consider the nearly half million patients who receive ESAs (erythypoiesis-stimulating agents) yearly, that amounts to a savings of over a billion dollars a year."

Copyright © 2008 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.