Patients receiving chemotherapy frequently experience anemia, which has a deleterious effect on patient outcome and quality of life. Interventions for treating chemotherapy-induced anemia include either oral or parenteral iron supplementation together with an erythropoiesis-stimulating agent (ESA). Data regarding the true advantages of oral versus parenteral iron supplementation when taken in combination with an ESA were unclear so a meta-analysis was carried out of eight randomized controlled trials that included over 1,600 patients.

This study, led by Fausto Petrelli, now confirms that in patients with cancer, the parenteral iron formulation significantly decreases the risk of red-blood-cell transfusion by 23% and increases the chance of a hematological response by almost 30% when compared with patients receiving ESA alone. Oral iron, however, did not induce these positive effects. Importantly, the meta-analysis did not reveal any significant differences in adverse effects between oral and parenteral iron formulations.

Overall, the researchers conclude that the findings from this study “confirm the general suggestions, derived from large randomized trials, that adding parenteral iron and not oral iron during treatment of chemotherapy-induced anemia with ESAs, should become standard of care in cancer patients with anemia.” The fact that intravenous iron is useful when added to ESAs has important clinical and economical implications. Non-responders to ESAs will have an improved quality of life and associated reduced costs if parenteral iron is used because once the target hematological response is reached, ESA treatment can cease; but, the optimal dose and combination needs to be found.