Researchers involved in a multicenter study have reported that iron supplementation improves the response of patients with chemotherapy-induced anemia to Aranesp (darbepoetin). The details of this study were presented at the 2007 meeting of the American Society of Clinical Oncology.

One of the unresolved issues related to treatment with epoetins is the role of supplemental iron.  An interim analysis of a European randomized trial presented at ASCO 2006 concluded that the combination of Aranesp and intraveneous (iv) iron may increase the proportion of patients with chemotherapy-induced anemia who achieve target hemoglobin levels, and decrease the proportion of patients requiring a blood transfusion (see first item of related news). This study was based on the results in 196 patients. At ASCO 2007 these same investigators reported the outcomes of 396 patients in the same study. Patients were randomized to receive Aranesp 500 mcg every three weeks with either IV iron (200 mcg every three weeks on the same schedule as Aranesp, or, if required, as two doses (200 mcg total) within a three-week period) or with iron administered according to standard practice (oral iron or no iron).

Outcomes were assessed between week five and the end of treatment and results were compared in patients with a hemoglobin of <10 or =10 g/dL at baseline. Target hemoglobin level was 11 g/dL.

Table 1 compares the results of supplemental IV iron in patients with a baseline hemoglobin <10 g/dL:

Table 2 compares the results of supplemental IV iron in patients with a baseline hemoglobin=10 g/dL:

These authors concluded that IV iron improved clinical outcomes, especially in patients with a baseline hemoglobin 10 g/dL. They suggest initiating Aranesp before the hemoglobin falls below 10 g/dL

Comments: These data suggest that patients with chemotherapy induced anemia benefit from IV iron supplementation in addition to Aranesp. However, it is probably better to administer iron only to patients who are truly iron deficient. The role of iron studies before treatment should be considered rather than giving parenteral iron to everyone.

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.

Related News:

Aranesp® Plus IV Iron May Benefit Patients with Chemotherapy-Induced Anemia (06/12/2006)

Intravenous Iron Enhances Response to Procrit® (04/13/2004)