Update on iron supplementation in patients with cancer-related anemia

ABSTRACT

Introduction

Numerous clinical trials affirm the efficacy and safety of IV iron to treat cancer-related anemia (CRA). Nonetheless, evaluation and treatment of CRA remains suboptimal.

Areas covered

This review summarizes CRA therapy with a focus on iron deficiency and its treatment. The literature search was conducted using the National Library of Medicine (PubMed) database from 2004 to 2024. Topics reviewed include CRA pathophysiology, laboratory diagnosis of iron deficiency, a summary of clinical trial results using IV iron to treat CRA, and safety aspects.

Expert opinion

Despite overwhelming positive efficacy and safety data, IV iron remains underutilized to treat CRA. This is likely due to persistent (unfounded) concerns about IV iron safety and lack of physician awareness of newer clinical trial data. This leads to poor patient quality of life and patient exposure to anemia treatments that have greater safety risks than IV iron. Solutions to this problem include increased educational efforts and considering alternative treatment models in which other providers separately manage CRA. The recent availability of new oral iron therapy products that are effective in treating anemia of inflammation has the potential to dramatically simplify the treatment of CRA.

KEYWORDS:

• Anemia
• iron deficiency
• hepcidin
• IV iron
• ferritin
• transferrin saturation
• hypersensitivity reactions
• erythropoiesis-stimulating agent

Article highlights

• A major contributor to cancer-related anemia is functional iron deficiency, caused by inflammation associated with cancer and its treatment.

• The hepcidin-ferroportin ‘iron block’ causing functional iron deficiency is best overcome using IV iron.

• Serum ferritin and transferrin saturation are useful tests in diagnosing and monitoring treatment of iron deficiency.

• Six IV iron products are available in the U.S.A.. All are efficacious, but one product (ferric gluconate) is associated with a higher risk of infusion reactions.

• Numerous clinical trials support using IV iron to treat CRA, either as IV iron monotherapy or in combination with erythropoiesis-stimulating agents.

• Iron deficiency associated with CRA is underdiagnosed and suboptimally treated.

• Misplaced safety concerns are a likely reason for the underutilization of IV iron to treat CRA.

• Serious adverse events (SAEs) associated with red cell transfusion are 10 times more common than SAEs associated with IV iron use.

• New oral iron products, such as sucrosomial iron and ferric maltol, appear to be effective in treating functional iron deficiency. These drugs may be potentially helpful in treating CRA.

Declaration of interest

GM Rodgers has been a consultant for Alexion and Novartis and has given CME presentations funded by American Regent. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.