Efficacy and safety of IV ferumoxytol for iron deficiency anemia in patients with cancer

Abstract

PurposeIron deficiency anemia (IDA) is common in cancer patients due to blood loss and inflammation. Many do not tolerate oral iron or adequately respond. Intravenous (IV) iron is commonly used as an adjunct to erythropoiesis-stimulating agents; data on the use of IV iron monotherapy in these patients are limited. This study aimed to evaluate IV ferumoxytol for the treatment of cancer patients with IDA with a history of unsatisfactory oral iron therapy or in whom oral iron could not be used.Patients and methodsThis post hoc analysis of pooled data from two multicenter, randomized, controlled, Phase III trials evaluating IV ferumoxytol (510 mg ×2) vs placebo or iron sucrose (200 mg ×5) included a subgroup of 98 patients with cancer that the investigator identified as the primary cause of their IDA, or with cancer whose IDA was attributed to another comorbid condition (ferumoxytol, n=75; iron sucrose, n=13; placebo, n=10). Gastrointestinal cancers were most common (42), followed by breast (14), cervix (ten), and lung (nine). The primary endpoint was the mean change in hemoglobin (Hgb) from baseline to week 5.ResultsAt week 5, both ferumoxytol and iron sucrose produced significant increases in Hgb from baseline (1.8 g/dL [P<0.0001] and 1.9 g/dL [P=0.002], respectively). During the studies, 45 patients received chemotherapy, 19 with platinum-based regimens. Erythropoiesis-stimulating agent doses were neither increased >20% nor initiated in any treatment group. Overall rates of adverse events and serious adverse events in the cancer subgroup mirrored those in the overall study population.ConclusionMonotherapy with IV iron appears to be an effective option for cancer patients with IDA who do not respond to or cannot tolerate oral iron therapy.

Nutritional Interventions for Treating Cancer-Related Fatigue: A Qualitative Review

“…Anemia-Anemia, particularly iron deficiency or vitamin B12 deficiency, is common in cancer patients and a contributor to fatigue and impaired physical function in cancer survivors (87,88). Iron-deficiency anemia occurs in over 30% of cancer survivors, with high prevalence in pancreatic cancer, gastrointestinal cancer and myeloma (88,89). Cancer survivors may develop anemia during or after treatment related to a number of stressors including nutritional deficiency, renal insufficiency, anemia of chronic disease, hemolysis, impaired erythropoiesis, inflammation, bleeding and abnormal tumor-associated vasculature (89,90).…”

“…Iron-deficiency anemia occurs in over 30% of cancer survivors, with high prevalence in pancreatic cancer, gastrointestinal cancer and myeloma (88,89). Cancer survivors may develop anemia during or after treatment related to a number of stressors including nutritional deficiency, renal insufficiency, anemia of chronic disease, hemolysis, impaired erythropoiesis, inflammation, bleeding and abnormal tumor-associated vasculature (89,90). Inflammation, often secondary to chemotherapy and radiation, further increases anemia (90).…”

“…Unfortunately, anemia of cancer has proven difficult to treat, remaining pervasive in survivors. Therapy by transfusion of packed red blood cells may lead to immunosuppressive effects and infection, while a number of cancer patients, including breast cancer survivors, experience venous thromboembolism due to erythropoiesisstimulating agents (89)(90)(91). Many cancer survivors have poor tolerance for oral iron supplementation or they do not experience meaningful improvement with oral supplements (89,92).…”

“…Therapy by transfusion of packed red blood cells may lead to immunosuppressive effects and infection, while a number of cancer patients, including breast cancer survivors, experience venous thromboembolism due to erythropoiesisstimulating agents (89)(90)(91). Many cancer survivors have poor tolerance for oral iron supplementation or they do not experience meaningful improvement with oral supplements (89,92). In recent studies in cancer patients with iron-deficiency anemia, intravenous iron supplementation appeared effective in many who had not improved with oral supplements, with significant improvements in both hemoglobin and fatigue symptoms (89,92).…”

Flipside of the Coin: Iron Deficiency and Colorectal Cancer

“…Intravenous (IV) iron can overcome the absorptive inflammatory blockade of iron, since iron is directly captured by the macrophages (33). There is growing evidence to support benefits of IV iron therapy (without additional ESAs) in patients with cancer (150)(151)(152)(153)(154)(155)(156)(157)(158)(159)(160) and IV iron has been shown to optimize preoperative hemoglobin levels specifically in patients with CRC (158)(159)(160)(161)(162)(163). On the other hand, in the extended IVICA trial, a randomized study including 116 patients with anemia and colorectal cancer treated preoperatively with oral or IV iron, no significant difference was found for 5-year overall survival or disease-free survival (164).…”