Iron or vitamin B12 deficiency in anemic cancer patients prior to erythropoiesis-stimulating agent therapy

Iron or vitamin B₁₂ deficiency in anemic cancer patients prior to erythropoiesis-stimulating agent therapy

David H. Henry, MD,¹ and Naomi V. Dahl, PharmD,² on behalf of the Ferrlecit Cancer Study Group

¹Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, and
²Watson Laboratories, Inc., Morristown, NJ

Common in patients with cancer, anemia is caused by factors including inflammatory cytokines, chemotherapy, and radiation therapy. Erythropoiesis-stimulating agents (ESAs) are an effective anemia treatment in these patients, but ~35% of patients do not achieve an adequate hematologic response. Supplemental parenteral iron therapy has improved the response to ESAs in some patients with chemotherapy-induced anemia (CIA). We initiated a trial to determine whether iron, oral or intravenous, would make a difference in hematologic response to epoetin alfa, compared with no iron, in iron-replete patients with cancer and anemia undergoing chemotherapy. During screening for enrollment in this study, we found a high prevalence of iron deficiency, as indicated by transferrin saturation levels < 20%, ferritin levels < 100 ng/mL, or reticulocyte hemoglobin concentration < 32 pg. In addition, a small number of anemic patients had vitamin B₁₂ deficiency despite normal mean corpuscular volume. The identification and treatment of iron or vitamin B₁₂ deficiency in patients with cancer and anemia should be performed prior to ESA therapy to optimize outcomes.

Commun Oncol 2007;4:95–101 print e-mail full text 406 kb