A Community Cancer Center Experience of the Efficacy and Safety of the Use of Intravenous Iron Dextran in Chemotherapy Induced Anemia.

An adequate level of hemoglobin is essential during chemotherapy in order to maintain an acceptable quality of life (QOL) and to prevent cancer related fatigue. The role of hematopoitic growth factors like Erythropoitin or Darbepoitin alfa in chemotherapy induced anemia is now well-accepted with the recommended goal being a hematocrit value of 33% approximately. It is also established that an iron-replete state is essential for proper response to the erythropoitic growth factors and IV iron supplementation has been in routine clinical use in long term hemodialysis patients. Unfortunately many cancer patients are nutritionally depleted and at the same time do not tolerate oral iron replacement. Intravenous iron preparations such as iron dextran or sodium ferric gluconate (Ferrlecit) are good alternatives because of their quick and predictable effect on erythropoisis. However due to heightened concern about infusion related serious side effects their use has not been widespread in community clinical practice. We present our experience of treating 30 patients (7 lung cancer, 6 breast cancer, 3 lymphoma, 6 colorectal, 4 ovarian, 4 others) in our center with documented chemotherapy induced anemia with supplemental intravenous iron. None of the patients had any history of untreated pretreatment iron deficiency anemia. Utilizing a premedication protocol of hydrocortisone 100mg, benadryl 25 mg and ranitidine 50 mg IV prior to iron infusion we could record only 2 cases with grade I/II (mainly nausea and dizziness) and none with grade III/IV acute infusion related toxicity. Only one patient required treatment interruption and no one required hospitalization due to adverse events. There was no death associated with this therapy. The pretreatment average hematocrit was 29.26% (range 26.4–32.3%). The average posttreatment hematocrit was 35.33% (range 33.1–44.6%) within an average of 4 weeks. All patients were treated with Erythropoitin (40,000 unit/wk) or Darbepoitin alfa (200 mg/14 days) during the period of observation. All patients received their respective chemotherapy for the primary cancer without interruption. The effect persisted over the next 10–14 weeks during which the primary therapy was continued. No long term adverse effect was observed during this period of observation.

Conclusion- This small observational study indicates that intravenous iron infusion is a safe procedure in the community cancer center setting. It has the potential of significantly augmenting the effect of erythropoitic growth factor therapy for chemotherapy induced anemia. Further studies are required to evaluate the routine use of intravenous iron in chemotherapy induced anemia similar to its use with erythropoitin in patients on chronic hemodialysis.