According to results presented at the 2007 annual meeting of the American Society of Clinical Oncology (ASCO), supplementation with intravenous iron improves outcomes of Aranesp® (darbepoetin alfa) among patients with chemotherapy-induced anemia.
Anemia is a common side effect of chemotherapy and cancer. It is characterized by low levels of circulating red blood cells, which are responsible for delivering oxygen to tissues throughout the body. Common symptoms of anemia are severe fatigue, shortness of breath, diminished activity levels, and a reduced overall feeling of well-being. A protein referred to as hemoglobin, found in red blood cells, is often used as an indicator of anemia.
Severe anemia often requires treatment with blood transfusions, which have associated risks of infection, rejection, and increased medical costs. Furthermore, severe anemia may cause a delay in cancer treatment.
In cancer patients use of red blood cell boosters-also called epoetins, such as Aranesp® (darbepoetin alfa) and Procrit® (epoetin alfa)-has been shown to decrease the need for blood transfusions in patients with chemotherapy-induced anemia. Because of adverse health effects reported in some studies, however, the FDA advises physicians to use the lowest possible dose to avoid transfusions and to use red blood cell boosters only as indicated.
One of the unresolved issues related to treatment with blood cell boosters is the role of supplemental iron. To further evaluate how the addition of intravenous (IV) iron affects anemia outcomes in patients receiving Aranesp, researchers from Europe recently conducted a clinical trial in which 396 patients with chemotherapy-induced anemia were treated with either Aranesp and IV iron or Aranesp with no iron or oral iron.
- Among patients with hemoglobin levels less than 10 g/dL upon initiation of the trial, 31% of patients who received oral or no iron supplementation still required blood transfusions, compared with only 11% who received IV iron supplementation.
- Among patients with hemoglobin levels equal to 10 g/dL upon initiation of the trial, 14% of those who received no iron or oral iron still required blood transfusions, compared with only 8% of those who received IV iron supplementation.
- Improvements in hemoglobin levels were achieved with a larger portion of patients who received IV iron than those who received no iron or oral iron.
The researchers concluded that IV iron supplementation among patients treated with Aranesp for chemotherapy-induced anemia significantly reduces blood cell transfusions and improves hemoglobin levels compared with no iron or oral iron supplementation in these patients. Further study is required to evaluate the benefit of IV iron supplementation among patients with specific iron levels and chemotherapy-induced anemia.
Reference: Pinter T, Mossman T, Suto T, et al. Effects of intravenous (IV) iron supplementation on responses to every-3 week (Q3W) darbepoetin alfa (DA) by baseline hemoglobin in patients (pts) with chemotherapy-induced anemia (CIA). Proceedings from the American Society of Clinical Oncology. Chciago, IL. 2007. Abstract # 9106.
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