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Diagnosis, treatment, and use of intravenous iron for chemotherapy-induced anemia in Europe.
Abstracts that were granted an exception in accordance with ASCO's Conflict of Interest Policy are designated with a caret symbol (^).
Background: Chemotherapy-induced anemia (CIA) is a frequent complication in cancer patients. Intravenous (I.V.) iron in conjunction with an erythropoiesis-stimulating agent (ESA) is a well tolerated and effective therapy. This study evaluated current practice in diagnosis and treatment of CIA in nine European countries. Methods: Onco-hematologists completed records on their last five patients treated for CIA within six months prior to the survey. Data were collected from Jun-Oct 2009 (France, Germany, Spain, Switzerland, UK) and Aug-Nov 2010 (Austria, Italy, Netherlands, Sweden). Results are presented as median [range] between countries. Results: 1,730 cases were recorded by 375 physicians (321 hospital and 54 office-based). Lymphoma, myeloma, breast and lung cancer accounted for 60% [50-66%] of cases; 52% [30-60%] had metastatic disease. Blood tests at diagnosis of anemia included hemoglobin (Hb, 96% [86-99%]), ferritin (49% [23-60%]) and transferrin saturation (TSAT, 12% [2-25%]). Median Hb before treatment was comparable between countries (9.1 g/dL [9.0-9.6 g/dL]), but ferritin (127 µg/L [50-243 µg/L]) and TSAT (26% [15-35%]) varied more. At diagnosis, 75% [65-89%] had an Hb <10 g/dL and 14% [8-25%] an Hb <8g/dL, 44% [21-65%] had a ferritin <100 µg/L and 20% [8-41%] had a ferritin <30 µg/L. 73% [15-100%] of CIA patients were treated with an ESA and iron was given to 22% [11-61%]. Although iron was mainly given in combination with an ESA (57% [17–100%]), I.V. iron was used in only 19% [4-77%] of iron-treated patients. Notably, Switzerland was the sole country where more patients received I.V. than oral iron. A blood transfusion was given to 52% [11-93%] of patients at some stage of treatment. Conclusions: Iron status assessment and treatment of CIA vary in manner and frequency between European countries. Ferritin and TSAT, markers of absolute and functional iron deficiency (AID, FID) are underused. Only a small fraction of cancer patients with CIA receives I.V. iron therapy despite clinical evidence on the efficacy of I.V. iron compared to oral iron in supplementing ESA-based anemia treatment. Awareness of evidence on the role of I.V. iron to resolve ID and prevent FID in CIA patients needs to be broadened.
Abstracts by M. S. Aapro:
Phase III study of NEPA, a fixed-dose combination of netupitant (NETU) and palonosetron (PALO), versus PALO for prevention of chemotherapy-induced nausea and vomiting (CINV) following moderately emetogenic chemotherapy (MEC).Meeting: 2013 ASCO Annual Meeting | Abstract No: LBA9514
Effect of age on treatment outcome to palonosetron (PALO) plus 1-day dexamethasone (DEX) for the prevention of nausea and vomiting in women receiving anthracycline plus cyclophosphamide (AC)-based chemotherapy: A meta-analysis of two phase III trials.Meeting: 2011 ASCO Annual Meeting | Abstract No: e19536