Should intravenous iron be the standard of care in oncology?

Before 1989, when epoetin was introduced for dialysisassociated
anemia, the use of intravenous (IV) iron in the United
States was typically avoided. Shortly thereafter, it was shown that
responses to epoetin could be improved by IV iron supplementation.
By 1998, IV iron had become standard of care in dialysis patients
receiving epoetin,1and the use of erythropoiesis-stimulating agents
(ESAs) in oncology patients was in its infancy. In the ensuing decade,
we have witnessed improvements in quality of life and fewer transfusions
among patients receiving ESAs for the anemia associated with
cancer and cancer chemotherapy. Some studies have shown the maximumimprovement
in energy, activity, and quality of life occurswhen
the hemoglobin (Hb) increases from 11 to 13 g/dL.2 In August 2007,
the Committee on Medicare and Medicaid Services issued a Decision
Memo restricting ESA usage when patients’ Hb levels are
10 g/dL.
These new regulations were recommended on the basis of data suggesting
harm with ESAs when used outside of established guidelines.
To date, no study has shown a negative impact on cancer outcomes or
survival in patients when ESAs were used in accordance with previously
established American Society of Hematology, American Society
of Clinical Oncology, or National Comprehensive Cancer Network
guidelines. Recent data in the renal literature suggest that it is not the
Hb level, but ESA exposure, that is associated with negative
outcomes.