title: Phase III, randomized study of the effects of parenteral iron, oral iron, or no iron supplementation on the erythropoietic response to darbepoetin alfa for patients with chemotherapy-associated anemia.
abstract: OBJECTIVE
  Functional iron deficiency may impair response to erythropoiesis-stimulating agents (ESAs) in iron-replete patients with chemotherapy-associated anemia (CAA). This study evaluated whether coadministration of parenteral iron improves ESA efficacy in patients with CAA.
  
  
  METHODS
  This prospective, multicenter, randomized trial enrolled 502 patients with hemoglobin (Hb) less than 11 g/dL who were undergoing chemotherapy for nonmyeloid malignancies. All patients received darbepoetin alfa once every 3 weeks and were randomly assigned to receive either ferric gluconate 187.5 mg intravenously (IV) every 3 weeks, oral daily ferrous sulfate 325 mg, or oral placebo for 16 weeks.
  
  
  RESULTS
  There was no difference in the erythropoietic response rate (ie, proportion of patients achieving Hb ≥ 12 g/dL or Hb increase ≥ 2 g/dL from baseline): 69.5% (95% CI, 61.9% to 76.5%) of IV iron-treated patients achieved an erythropoietic response compared with 66.9% (95% CI, 59.1% to 74.0%) who received oral iron and 65.0% (95% CI, 57.2% to 72.3%) who received oral placebo (P = .75). There were also no differences in the proportion of patients requiring red cell transfusions, changes in quality of life, or the dose of darbepoetin administered. Adverse events (AEs) tended to be more common in the IV iron arm: grade 3 or higher AEs occurred in 54% (95% CI, 46% to 61%) of patients receiving IV iron compared with 44% (95% CI, 36% to 52%) who received oral iron and 46% (95% CI, 38% to 54%) who received oral placebo (P = .16).
  
  
  CONCLUSIONS
  In patients with CAA, addition of IV ferric gluconate to darbepoetin failed to provide additional benefit compared with oral iron or oral placebo.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney St, Suite D1B30, Boston, MA 02115, USA. david_steensma@dfci.harvard.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Steensma
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Shaker R
authors.initials: SR
authors.lastname: Dakhil
authors.forename: Robert
authors.initials: R
authors.lastname: Dalton
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Kahanic
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Prager
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Stella
authors.forename: Kendrith M
authors.initials: KM
authors.lastname: Rowland
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Novotny
authors.forename: Charles L
authors.initials: CL
authors.lastname: Loprinzi
mesh_terms: D000284:Administration, Oral; D000740:Anemia / Q000139:chemically induced / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068256:Darbepoetin alfa; D019587:Dietary Supplements; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents; D005290:Ferric Compounds; D006397:Hematinics; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D007501:Iron; C035552:ferric gluconate