Iron-deficiency anemia evaluation and treatment in hospitalized cancer patients: a feasibility study

Cancer-associated anemia is multifactorial, resulting from both the malignancy itself and its treatment. It is frequently accompanied by absolute or functional iron deficiency. While intravenous (IV) iron is a well-established treatment in outpatients, evidence is lacking in cancer patients hospitalized for acute complications. We conducted a feasibility study to evaluate the practicality of administering intravenous ferric carboxymaltose (FCM) in this population.

This feasibility study includes cancer patients who have been hospitalized for acute cancer complications and biological evidence of iron deficiency. Exclusion criteria apply to patients with hemoglobin levels below 7 g/dL, active bleeding or contraindications to iron carboxymaltose. Participants received a single IV infusion of FCM (1000 mg). Primary objectives were to assess feasibility and characterize anemia etiology; secondary objectives were hemoglobin response, transfusion requirements within 4 weeks, and exploratory predictive biomarkers.

Of 55 enrolled patients, 51 received FCM. Response rates-defined as a hemoglobin increase ≥1 g/dL were 33% at week 2 and 39% at week 4. Transfusion rates reached 15% by day 28. No reliable predictive biomarkers were identified.

Our results suggest that a single dose of IV FCM is effective in increasing hemoglobin levels. No predictive biomarkers were identified, likely due to the modest sample size, advanced disease, and complex inpatient status. IV iron supplementation trials in this population are feasible; multicentric trials are needed to enroll larger samples. Furthermore, quality-of-life endpoints should be incorporated, which were difficult to capture here.