IV iron sucrose for cancer and/or chemotherapy-induced anemia in patients treated with erythropoiesisstimulating agents

Intravenous (IV) iron is commonly administered with erythropoiesis-stimulating agents (ESAs) in patients with anemia associated with chronic kidney disease. Several studies have yielded positive results with the use of IV iron replacement in patients with cancer and/or chemotherapy-induced anemia (CCIA). To investigate whether IV iron sucrose is an effective and safe way to manage CCIA in patients treated with ESAs, the authors conducted a randomized, controlled trial of 375 patients with CCIA (hemoglobin [Hgb] level ≤ 10 g/dL). Compared with ESAs alone, iron sucrose plus ESAs resulted in higher maximum Hgb levels, and Hgb level increases ≥ 2 g/dL and ≥ 3 g/dL were achieved in both prior ESA responders and nonresponders. Iron sucrose also resulted in a statistically significant improvement in Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scores. Three serious but nonlife-threatening iron sucrose-related adverse events were observed, including one case of significant, transient hypotension in a woman weighing 50 kg. The authors conclude that the combination of ESA therapy and IV iron sucrose (in individual doses of up to 500 mg) may prove to be an effective and safe way to increase Hgb levels and improve quality of life in this patient population regardless of the prior response to ESAs and iron indices.