gms | German Medical Science

Introduction: Due to the prevalence of functional iron deficiency in many cancer patients, a hematological response to epoetin treatment may be reduced. Recent studies suggest a markedly increased hematological response to epoetin treatment when patients with reduced availability of functional iron (TSAT < 20%) are given intravenous iron together with epoetin therapy. To assess the value of these findings in the daily practice of our outpatient clinic, we evaluated incidence, prevalence and therapy of anemia and functional iron deficiency in cancer patients.

Patients and methods: 60 consecutive patients with breast cancer undergoing adjuvant chemotherapy (73% receiving epirubicin (E) 100mg/m2, Cyclophosphamid (C) 600 mg/m2 administered on day 1 every 3 wks , 4 cycles, 26% receiving EC followed by docetaxel 1000 mg/m2 or paclitaxel 175mg/m2 every 3 wks , 4 cycles) received Epoetin beta (NeoRecormon®) 30.000 IU per week when Hb-levels dropped below 11 g/dl, with the aim to correct the anemia and stabilize Hb-values in the range of 12-13 g/dl, according to the EORTC guidelines. Iron parameters (Ferritin, TSAT) were monitored throughout the therapy, and intravenous iron supplementation was given when TSAT was below 20%.

Results: Median Hb-level at baseline was 13 g/dl. During CT, Hb-levels dropped below 11 g/dl after a median time of 5 weeks in 43 patients (72%), and epoetin therapy was initiated. The median time to response to Epoetin beta treatment was 4 weeks. 63% of the patients who received Epoetin treatment reached target Hb-levels above 12g/dl, and an additional 7% of patients had their Hb-levels stabilised above 11 g/dl. The median Hb-levels after 12 weeks of Epoetin therapy reached 11.4 g/dl. Iron parameters (TSAT, Ferritin and serum iron) were within the normal range in all but 2 patients, who received intravenous iron (TSAT < 20%). Only one patient required blood transfusions.

Conclusion: We found that over 70% of patients with breast cancer receiving adjuvant CT developed anemia at some time during adjuvant CT. Treatment with Epoetin beta proofed to be a highly effective therapy in these patients. The incidence of functional iron deficiency measured as TSAT < 20%, is low and therefore does not seem to be a critical aspect in this patient group.