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Parenteral iron with erythropoiesis-stimulating agents for chemotherapy-induced anemia

University of Illinois College of Pharmacy, University of Illinois Medical Center at Chicago, sshord{at}uic.edu

J.M. Hamilton, Jr, PharmD

University of Illinois College of Pharmacy

Sandra Cuellar, PharmD BCOP

University of Illinois College of Pharmacy, University of Illinois Medical Center at Chicago

Purpose. To discuss the clinical issues we addressed in the development of our institutional guidelines regarding the assessment of iron stores for cancer- and treatment-related anemia and the administration of parenteral iron with erythropoiesis-stimulating agents (ESAs).

Data sources. Studies published from January 1995 to August 2007 were identified by computer searches of Medline and hand searching of bibliographies of the articles identified via the computer searches. The current clinical practice guidelines were identified by computer searches of the web sites for national professional organizations that represent health care professionals who treat patients with cancer.

Results of data analysis. Hematopoietic responses demonstrate that epoetin alfa and darbepoetin alfa provide similar outcomes for patients with chemotherapy-induced anemia (CIA); however, up to 50% of patients receiving these agents fail to adequately respond. Functional iron deficiency defined as a state of iron-restricted erythropoiesis is likely the primary contributor to the lack of response. Hematopoietic responses following ESA therapy with parenteral iron are substantially higher compared to response with no or oral iron.

Conclusions. Iron stores should be assessed in all patients with cancer- or treatment-related anemia and parenteral iron should be administered to patients receiving ESA therapy to improve hematopoietic response. A unique algorithm that summarizes our institutional guidelines to assess iron stores and administer parenteral iron with ESA therapy in patients with CIA is included. J Oncol Pharm Practice (2008) 14: 5—22.

Key Words: anemia • cancer • chemotherapy • iron • erythropoiesis stimulating agents

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