The effect of intravenous iron therapy on long-term survival in anaemic colorectal cancer patients: Results from a matched cohort study

Wilson, M.; Dekker, Jan Willem T.; Buettner, Stefan; Harlaar, Joris Jan; Jeekel, J.; Schipperus, Martin R.; Zwaginga, Jaap Jan

doi:10.1016/j.suronc.2018.03.005

Cited by 19 publications

(30 citation statements)

References 29 publications

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“…As for short‐term intravenous iron administration, no tissue damage due to oxidative stress by labile iron could be expected . In fact, a recent study showed that 1000–2000 mg preoperative intravenous iron therapy does not have a profound effect on long‐term overall and disease‐free survival in anaemic colorectal cancer patients .…”

Section: Discussionmentioning

confidence: 99%

Short‐term perioperative iron in major orthopedic surgery: state of the art

Gómez‐Ramírez

Maldonado-Ruiz²,

Campos-Garrigues

et al. 2018

Vox Sanguinis

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In major orthopaedic surgery, it is recommended to detect and correct preoperative anaemia several weeks prior to surgery. However, in many cases, the procedure is urgent or the patient is evaluated shortly before the intervention. As iron deficiency is the leading cause of perioperative anaemia, an exhaustive review of the literature was performed to assess the efficacy and safety of short‐term perioperative intravenous, with or without erythropoietin, or postoperative oral or intravenous supplementation in major orthopaedic surgery. Overall, 20 studies met the inclusion criteria. There were 13 randomized trials (moderate quality) and seven observational studies (low to very low quality). The primary outcomes were reduction in transfusion requirements, haemoglobin increase and medication side‐effects during the study period. Data analysis showed that postoperative oral iron administration neither increased haemoglobin nor reduced transfusion requirements, and it was associated with significant gastrointestinal adverse effects (15%). In contrast, for some patient populations, perioperative or postoperative administration of intravenous iron, with or without recombinant erythropoietin, may reduce transfusion requirements and/or hasten the recovery from postoperative, with few clinically relevant adverse effects (<2%). However, discrepancies between randomized trials and observational studies on the possible beneficial effects of short‐term perioperative intravenous iron administration were found for patients undergoing surgery for hip fracture repair. Further studies are needed to elucidate when the treatment should be started, which combination of drugs should be used, and which patient groups would be most benefit.

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Section: Discussionmentioning

confidence: 99%

Short‐term perioperative iron in major orthopedic surgery: state of the art

Gómez‐Ramírez

Maldonado-Ruiz²,

Campos-Garrigues

et al. 2018

Vox Sanguinis

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“…In 2015, a prospective randomized controlled trial evaluating treatment with IV iron and ESAs in a small number of patients with hematological malignancies and median follow-up of 1.4 years, did not find any negative effect on long-term outcomes or survival [100]. More recently, a retrospective cohort study, including patients who underwent surgery for colorectal carcinoma with an extended follow-up (median 3.9 years), confirmed that overall and disease-free survivals did not significantly differ in subjects treated with IV iron (FCM in the range of 1000–2000 mg) as compared to a matched group not receiving IV iron [101].…”

Section: Possible Risks Of Iron Treatment In Cancer Patients: Mythmentioning

confidence: 99%

Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy

et al. 2018

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Anemia in cancer patients is quite common, with remarkable negative impacts on quality of life and overall prognosis. The pathogenesis is complex and typically multifactorial, with iron deficiency (ID) often being a major and potentially treatable contributor. In turn, ID in cancer patients can be due to multiple concurring mechanisms, including bleeding (e.g., in gastrointestinal cancers or after surgery), malnutrition, medications, and hepcidin-driven iron sequestration into macrophages with subsequent iron-restricted erythropoiesis. Indeed, either absolute or functional iron deficiency (AID or FID) can occur. While for absolute ID there is a general consensus regarding the laboratory definition (that is ferritin levels <100 ng/mL ± transferrin saturation (TSAT) <20%), a shared definition of functional ID is still lacking. Current therapeutic options in cancer anemia include iron replacement, erythropoietic stimulating agents (ESAs), and blood transfusions. The latter should be kept to a minimum, because of concerns regarding risks, costs, and limited resources. Iron therapy has proved to be a valid approach to enhance efficacy of ESAs and to reduce transfusion need. Available guidelines focus mainly on patients with chemotherapy-associated anemia, and generally suggest intravenous (IV) iron when AID or FID is present. However, in the case of FID, the upper limit of ferritin in association with TSAT <20% at which iron should be prescribed is a matter of controversy, ranging up to 800 ng/mL. An increasingly recognized indication to IV iron in cancer patients is represented by preoperative anemia in elective oncologic surgery. In this setting, the primary goal of treatment is to decrease the need of blood transfusions in the perioperative period, rather than improving anemia-related symptoms as in chemotherapy-associated anemia. Protocols are mainly based on experiences of Patient Blood Management (PBM) in non-oncologic surgery, but no specific guidelines are available for oncologic surgery. Here we discuss some possible approaches to the management of ID in cancer patients in different clinical settings, based on current guidelines and recommendations, emphasizing the need for further research in the field.

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“…Equally, the enteral accumulation of unabsorbed OI may promote tumour growth and spread. Previous cohort studies have aimed to evaluate the impact of IVI alone on long-term postoperative survival but a comparison to OI treatment is yet to be undertaken [17]. To address this we will analyse the long-term outcomes of patients enrolled in the Intravenous Iron for Colorectal Cancer Associated Anaemia (IVICA) trial [6].…”

Section: Introductionmentioning

confidence: 99%

Preoperative intravenous iron therapy and survival after colorectal cancer surgery: long‐term results from the IVICA randomised controlled trial

Dickson

Keeler

et al. 2020

Colorectal Disease

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Aim Preoperative iron is frequently used for the correction of anaemia in colorectal cancer surgery. However, enteral iron intake may promote tumour growth and progression which could influence cancer recurrence and patient survival. We explore the long-term outcomes of patients receiving either oral or intravenous iron replacement therapy as part of a previous randomized controlled trial. Methods The IVICA trial randomized anaemic colorectal cancer patients to receive either oral (OI, control) or intravenous (IVI, treatment) iron prior to their elective operation. Follow-up analysis of all patients recruited to this multicentre trial who underwent surgical resection with curative intent was performed. Kaplan-Meier survival estimates and Cox proportional hazard models were used to compare groups. A pooled group multivariable analysis comparing patients who achieved resolution of anaemia preoperatively to those who did not was also undertaken. Results In all, 110 of the 116 patients previously enrolled were eligible for analysis (OI n = 56, IVI n = 54). Median overall follow-up duration was 61 months (interquartile range 46-67). No significant difference in 5-year overall survival (hazard ratio (HR) 1.22, 95% CI 0.65-2.28, P = 0.522) or disease-free survival (HR 1.08, 95% CI 0.61-1.92, P = 0.79) was observed between OI and IVI. A pooled analysis of treatment groups found that preoperative resolution of anaemia led to improved 5-year overall survival on multivariable analysis (HR 3.38, 95% CI 1.07-11.56, P = 0.044). Conclusion We recommend IVI for the preoperative correction of anaemia. Route of iron therapy did not significantly influence survival. Preoperative anaemia correction may lead to an overall survival advantage following elective colorectal cancer surgery.

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The effect of intravenous iron therapy on long-term survival in anaemic colorectal cancer patients: Results from a matched cohort study

Cited by 19 publications

References 29 publications

Short‐term perioperative iron in major orthopedic surgery: state of the art

Short‐term perioperative iron in major orthopedic surgery: state of the art

Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy

Preoperative intravenous iron therapy and survival after colorectal cancer surgery: long‐term results from the IVICA randomised controlled trial

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