Patients with
cancer may have an absolute or functional
iron deficiency as a result of their disease or its treatment. These conditions can lead to an insufficient supply of
iron for incorporation into erythrocytes during supportive care with erythropoiesis-stimulating
proteins for
chemotherapy. The use of supplemental
iron therapy is well established in patients with
chronic kidney disease and
anemia, but less well studied in the oncology/hematology setting. Furthermore, the use of oral
iron formulations in patients with
cancer and
anemia is limited by poor absorption in the duodenum, arduous dosing requirements (three times a day), and a high likelihood of gastrointestinal side effects. Two recent studies have shown that intravenous (i.v.)
iron (
iron dextran or
ferric gluconate) increases the hematopoietic response rates in
cancer patients who were receiving
chemotherapy and treated with
epoetin alfa (
Procrit) for
anemia. The effects on
hemoglobin levels and measures of
iron metabolism were notably greater with i.v.
iron formulations than with oral
iron formulations. The results from several ongoing trials of i.v.
iron in patients treated with
epoetin alfa or
darbepoetin alfa (
Aranesp) for
chemotherapy-induced
anemia should lead to a greater understanding of the role of i.v.
iron supplementation in improving the hematopoietic responses in these patients.