Role of iron in optimizing responses of anemic cancer patients to erythropoietin

Approximately 50% of cancer patients develop anemia, In the past, the only available treatment option for these patients was transfusion. Since the la te 1980s, recombinant human erythropoietin (rHuEPO, epoetin alfa [Epogen, P rocrit]) has provided a treatment alternative. Controlled clinical trials h ave shown that rHuEPO increases hemoglobin and hematocrit levels and reduce s the need for transfusions in patients with cancer-related anemia, These c ontrolled trials have suggested (as have larger, uncontrolled studies) that the improvements in hemoglobin are associated with increases in energy lev el, functional status, and overall quality of life. However, only about 50% of patients respond adequately to usual noses of rHuEPO. In the chronic re nal failure population, functional iron deficiency is the most common cause of inadequate response to rHuEPO. It has been hypothesized that functional iron deficiency may also occur in cancer patients receiving rHuEPO and may account for the lack of response in up to half of those patients, Studies in renal failure patients have shown that administration of intravenous iro n can correct functional ii-on deficiency more effectively than oral iron a nd may improve response to rHuEPO. intravenous iron also reduces the fetal amount of rHuEPO needed to normalize hematocrit and hemoglobin levels, ther eby reducing treatment costs. Ongoing clinical trials are evaluating whethe r IV iron can also improve rHuEPO responsiveness in patients with cancer-re lated anemia.