Date Published: 
Tuesday, 7 October, 2014

Pre-operative intravenous iron therapy may increase haemoglobin in patients with colorectal cancer, study indicates

Dr Matt Brookes

Keeler and colleagues recently provided further evidence to support the use of intravenous iron to treat the anaemia associated with colorectal adenocarcinoma. This small open-label study was in the pre-operative setting, where previous studies have demonstrated that untreated anaemia can contribute to adverse postoperative outcomes.

In the latest pilot study, the authors administered ferric carboxymaltose for the treatment of anaemia. Twenty anaemic patients were administered a single 1000 mg dose of intravenous ferric carboxymaltose at least 2 weeks prior to colorectal cancer surgery. The drug was administered in the out-patient setting, which was intended to reflect a routine surgical pre-assessment clinic appointment.

Results showed a significant rise in median haemoglobin of 1.8 g/dl prior to surgery, which was achieved at 27.5 days (median; interquartile range: 16–43 days) after administration of the ferric carboxymaltose. The authors also investigated predictive biomarkers to identify those patients most likely to respond to ferric carboxymaltose.  Patients who responded were shown to have a significantly lower haemoglobin and a higher erythropoietin level. There was no difference in serum ferritin or hepcidin levels between responder and non-responder groups.

This pilot study highlights the need for larger studies to evaluate the role of strategies to treat anaemia in this pre-operative cohort. Future research may be able to expand on the usefulness of biomarkers to predict those patients who are likely to respond to iron therapy. If these studies are successful it would potentially allow treatment to be focused on those patients who are most likely to benefit, which may improve the cost-effectiveness of treatment.