The VITAL protocol: Expert opinion on a validated iron treatment algorithm for low hemoglobin in cancer patients in India

Anemia is a prevalent and clinically significant complication in patients with cancer, often exacerbated by chemotherapy. Iron correction remains an important component of treatment. Iron-deficiency anemia (IDA) is generally challenging to manage using oral formulations due to limited absorption, poor tolerability, and the need for rapid correction. Ferric carboxymaltose (FCM), a dextran-free preparation that delivers up to 1000 mg of iron in ≤15 minutes, was developed to address these challenges, making it a suitable treatment option for patients with IDA who cannot tolerate or do not respond to oral iron therapy. However, its real-world use in Indian oncology practice remains limited. To address this gap, an expert advisory board was convened to discuss the role of intravenous FCM 1000 mg in managing IDA among patients with cancer in India. The experts highlighted the significant burden of IDA in both hematologic and solid tumors, particularly gastrointestinal cancers, and emphasized the importance of iron profiling for accurate diagnosis. FCM 1000 mg was identified as the preferred treatment over oral iron in chemotherapy settings and was recommended as first-line therapy across the cancer care continuum due to its clinical efficacy, tolerability, patient quality of life benefits, cost-effectiveness, and ability to support uninterrupted chemotherapy. These expert insights are expected to provide a practical framework for Indian oncologists to improve IDA diagnosis and management, ultimately improving clinical outcomes and patient well-being.