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Cancer-related anemia (CRA) is a frequent complication in oncology patients, significantly affecting quality of life and treatment outcomes.
High-dose intravenous iron monotherapy (ferric carboxymaltose or ferric derisomaltose) improves hemoglobin levels and reduces transfusion need in cancer-related anemia, with a strong safety profile.
Cancer-related anemia (CRA) is a frequent complication in oncology patients, significantly affecting quality of life and treatment outcomes. For chemotherapy-triggered anemia, erythropoiesis-stimulating agents (ESAs) are not approved in Japan, creating a need for effective alternative therapies.
New-generation intravenous (IV) iron formulations, including ferric carboxymaltose (FCM) and ferric derisomaltose (FDI), allow rapid high-level iron restoration. However, real-world data on IV iron monotherapy in ESA-restricted oncology settings remain limited. This retrospective study explored the efficiency and safety of high-dose IV iron therapy in CRA.
Researchers recruited 55 individuals diagnosed with cancer-related anemia who received high-dose IV iron (FCM or FDI). Subjects were categorized based on iron status into absolute iron deficiency, functional iron deficiency, or non-iron deficiency. The key outcome was the alteration in hemoglobin (Hb) levels from baseline to nearly 1 month (21–45 days) in those who did not undergo transfusion. Secondary outcomes included hemoglobin response rate (ΔHb ≥1.0 g/dL), transfusion avoidance rate, iron dosing adequacy on the basis of the Ganzoni formula, and treatment safety, with special attention to hypophosphatemia.
Among non-transfused patients, mean hemoglobin levels elevated markedly from 8.76 ± 1.34 g/dL to 9.73 ± 1.75 g/dL (mean ΔHb +0.92 ± 1.44 g/dL). The response rate was 48.9%, while transfusion avoidance was attained in 81.8% of patients, highlighting the clinical utility of IV iron therapy. Functional iron deficiency was the most common subtype (52.7%) and exhibited meaningful hematologic improvement.
Approximately 38.2% of subjects received optimal dosing (~1000 mg) based on calculated iron deficit. The safety profile was favorable, with no infusion-linked reactions or symptomatic hypophosphatemia noted. Median serum phosphate levels illustrated only a minimal change.
In an ESA-restricted oncology setting, high-dose IV iron monotherapy (FCM or FDI) proved safe and effective for mitigating cancer-related anemia, resulting in substantial hemoglobin improvement and high transfusion avoidance rates within a short-term follow-up. A proactive, transferrin saturation-guided treatment strategy may optimize outcomes. Nevertheless, further large-scale studies are warranted to determine the long-term efficiency, optimal dosing protocols, and broader generalizability.
Cancers (Basel)
High-Dose Intravenous Ferric Carboxymaltose/Derisomaltose Without ESAs for Cancer-Related Anemia in Japan: A Retrospective Single-Center Cohort Study
Shinya Kajiura et al.
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