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[G-CSF for prophylaxis of neutropenia and febrile neutropenia, anemia in cancer : Guidelines on supportive treatment part 1]. Urologe A 2022; 61:537-551. [PMID: 35476110 PMCID: PMC9044390 DOI: 10.1007/s00120-022-01831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 02/01/2023]
Abstract
Infections in patients with neutropenia following chemotherapy are mostly manifested as fever (febrile neutropenia, FN). Some of the most important determinants of the risk of FN are the type of chemotherapy, the dose intensity and patient-specific factors. When the risk of FN is 20% or more granulopoiesis is prophylactically stimulated with granulocyte colony stimulating factor (G-CSF) after the treatment. Anemia should always be clarified and if necessary be treated according to the cause when symptomatic. If an absolute or functional iron deficiency is present, intravenous iron substitution is mostly necessary. Erythropoiesis-stimulating agents can be used after chemotherapy with hemoglobin (Hb) levels less than 10 g/dl (6.2 mmol/l). In cases of chronic anemia and Hb levels less than 7-8 g/dl (<4.3-5.0 mmol/l) the indications for transfusion of erythrocyte concentrates should be assessed primarily based on the individual clinical symptoms.
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Weigl A, Köhler N, Monsef I, Bohlius J, Kuhr K, Becker I, Skoetz N. Intravenous iron versus oral iron versus no iron with or without erythropoiesis- stimulating agents (ESA) for cancer patients with anaemia: A systematic review and network meta-analysis. Hippokratia 2017. [DOI: 10.1002/14651858.cd012633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aaron Weigl
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne NRW Germany 50937
| | - Nicola Köhler
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne NRW Germany 50937
| | - Ina Monsef
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne NRW Germany 50937
| | - Julia Bohlius
- University of Bern; Institute of Social and Preventive Medicine; Finkenhubelweg 11 Bern Switzerland 3012
| | - Kathrin Kuhr
- University Hospital of Cologne; Institute of Medical Statistics, Informatics and Epidemiology; Kerpener Str. 62 Cologne Germany 50937
| | - Ingrid Becker
- University Hospital of Cologne; Institute of Medical Statistics, Informatics and Epidemiology; Kerpener Str. 62 Cologne Germany 50937
| | - Nicole Skoetz
- University Hospital of Cologne; Cochrane Haematological Malignancies Group, Department I of Internal Medicine; Kerpener Str. 62 Cologne NRW Germany 50937
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Intravenous iron therapy for anemic cancer patients: a review of recently published clinical studies. Support Care Cancer 2017; 25:2313-2319. [PMID: 28386789 DOI: 10.1007/s00520-017-3672-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/14/2017] [Indexed: 12/17/2022]
Abstract
Based on available literature and on the present review, IV iron administration to anemic cancer patients can increase significantly the level of Hb, probably independently from the precise mechanism of anemia itself. However, in future studies, the benefit should be evaluated taking into account whether the anemia is due to absolute or functional iron deficiency; therapeutic modalities might be different for these two conditions. Along the same lines, it appears important to further evaluate the respective roles of PO and IV iron therapies and the modalities of their use in clinical practice. Until the results of such studies are available, it appears reasonable to propose IV iron therapy to anemic cancer patients as the resulting rise of Hb level may increase their quality of life and performance status and reduce the need for erythropoietin-stimulating agents and/or blood transfusions.
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Gemici C, Yetmen O, Yaprak G, Ozden S, Tepetam H, Ozyurt H, Mayadagli A. Is there any role of intravenous iron for the treatment of anemia in cancer? BMC Cancer 2016; 16:661. [PMID: 27542823 PMCID: PMC4992337 DOI: 10.1186/s12885-016-2686-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 08/07/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anemia is a major cause of morbidity in patients with cancer resulting in poor physical performance, prognosis and therapy outcome. The aim of this study is to assess the efficacy of intravenous (iv) iron administration for the correction of anemia, for the prevention of exacerbation of anemia, for decreasing blood transfusion rates, and for the survival of cancer patients. METHODS Patients with different solid tumor diagnosis who received iv iron during their cancer treatment were evaluated retrospectively. Sixty-three patients with hemoglobin (Hgb) levels between ≥ 9 g/dL, and ≤ 10 g/dL, and no urgent need for red blood cell transfusion were included in this retrospective analysis. The aim of cancer treatment was palliative for metastatic patients (36 out of 63), or adjuvant or curative for patients with localized disease (27 out of 63). All the patients received 100 mg of iron sucrose which was delivered intravenously in 100 mL of saline solution, infused within 30 min, 5 infusions every other day. Complete blood count, serum iron, and ferritin levels before and at every 1 to 3 months subsequently after iv iron administration were followed regularly. RESULTS Initial mean serum Hgb, serum ferritin and serum iron levels were 9.33 g/dL, 156 ng/mL, and 35.9 μg/dL respectively. Mean Hgb, ferritin, and iron levels 1 to 3 months, and 6 to 12 months after iv iron administration were 10.4 g/dL, 11.2 g/dL, 298.6 ng/mL, 296.7 ng/mL, and 71.6 μg/dL, 67.7 μg/dL respectively with a statistically significant increase in the levels (p < 0.001). Nineteen patients (30 %) however had further decrease in Hgb levels despite iv iron administration, and blood transfusion was necessary in 18 of these 19 patients (28.5 %). The 1-year overall survival rates differed in metastatic cancer patients depending on their response to iv iron; 61.1 % in responders versus 35.3 % in non-responders, (p = 0.005), furthermore response to iv iron correlated with tumor response to cancer treatment, and this relation was statistically significant, (p < 0.001). CONCLUSIONS Iv iron administration in cancer patients undergoing active oncologic treatment is an effective and safe measure for correction of anemia, and prevention of worsening of anemia. Amelioration of anemia and increase in Hgb levels with iv iron administration in patients with disseminated cancer is associated with increased tumor response to oncologic treatment and overall survival. Response to iv iron may be both a prognostic and a predictive factor for response to cancer treatment and survival.
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Affiliation(s)
- Cengiz Gemici
- Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Cevizli, Istanbul, Turkey.
| | - Ozlem Yetmen
- Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Cevizli, Istanbul, Turkey
| | - Gokhan Yaprak
- Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Cevizli, Istanbul, Turkey
| | - Sevgi Ozden
- Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Cevizli, Istanbul, Turkey
| | - Huseyin Tepetam
- Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Cevizli, Istanbul, Turkey
| | - Hazan Ozyurt
- Department of Oncology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Cevizli, Istanbul, Turkey
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Laï-Tiong F, Brami C, Dubroeucq O, Scotté F, Curé H, Jovenin N. Management of anemia and iron deficiency in a cancer center in France. Support Care Cancer 2015; 24:1091-6. [PMID: 26253586 DOI: 10.1007/s00520-015-2877-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/29/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE Anemia affects most patients treated for cancer by chemotherapy. It is a known major contributor to fatigue and loss of quality of life and is likely to have a negative effect on prognosis and mortality from cancer. The main purpose of this study was to characterize the management of anemia and iron deficiency in a French oncology day-care center. METHODS A retrospective study was conducted between May and November 2012 in the oncology day unit of the Jean Godinot Cancer Center (France). The 133 patients included were all over the age of 18 and being treated by chemotherapy and had mild, moderate, or severe anemia. RESULTS Over half (58%) the patients were shown to be receiving no specific treatment for anemia. Iron balance was assessed in 71 patients and iron deficiency diagnosed in 37. Stepwise logistic regression showed that patients with severe to moderate anemia were nearly four times more likely to have an iron balance assessment than those with mild anemia (OR, 3.78; 95% CI, 1.84-7.76; P = 0.0003). Classical logistic regression shows that older patients (≥70) are three times less likely to have an iron balance assessment than patients <70 years (OR, 0.32; 95% CI, 0.12-0.86; P = 0.06). CONCLUSION An ideal medical setting for the management of anemia and iron deficiency, and the associated quality-of-life concerns, has yet to be defined for patients with cancer. Screening and treatment of mild to moderate anemia are inadequate, despite the advent of erythropoiesis-stimulating agents. Large scale, multicenter studies are required to define a clear medical framework for the management of anemia and iron deficiency.
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Affiliation(s)
- Florence Laï-Tiong
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France.
| | - Cloé Brami
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
| | - Olivier Dubroeucq
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
| | | | - Hervé Curé
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
| | - Nicolas Jovenin
- Jean Godinot Unicancer Institute, 1 avenue du général Köenig, CS80014, 51726, Reims, France
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Ludwig H, Aapro M, Bokemeyer C, Glaspy J, Hedenus M, Littlewood T, Österborg A, Rzychon B, Mitchell D, Beguin Y. A European patient record study on diagnosis and treatment of chemotherapy-induced anaemia. Support Care Cancer 2014; 22:2197-206. [PMID: 24659244 PMCID: PMC4082648 DOI: 10.1007/s00520-014-2189-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/02/2014] [Indexed: 01/28/2023]
Abstract
Purpose Patients with cancer frequently experience chemotherapy-induced anaemia (CIA) and iron deficiency. Erythropoiesis-stimulating agents (ESAs), iron supplementation and blood transfusions are available therapies. This study evaluated routine practice in CIA management. Methods Medical oncologists and/or haematologists from nine European countries (n = 375) were surveyed on their last five cancer patients treated for CIA (n = 1,730). Information was collected on tests performed at diagnosis of anaemia, levels of haemoglobin (Hb), serum ferritin and transferrin saturation (TSAT), as well as applied anaemia therapies. Results Diagnostic tests and therapies for CIA varied across Europe. Anaemia and iron status were mainly assessed by Hb (94 %) and ferritin (48 %) measurements. TSAT was only tested in 14 %. At anaemia diagnosis, 74 % of patients had Hb ≤10 g/dL, including 15 % with severe anaemia (Hb <8 g/dL). Low-iron levels (ferritin ≤100 ng/mL) were detected in 42 % of evaluated patients. ESA was used in 63 % of patients, blood transfusions in 52 % and iron supplementation in 31 % (74 % oral, 26 % intravenous iron). Only 30 % of ESA-treated patients received a combination of ESA and iron supplementation. Blood transfusions formed part of a regular anaemia treatment regimen in 76 % of transfused patients. Management practices were similar in 2009 and 2011. Conclusion Management of anaemia and iron status in patients treated for CIA varies substantially across Europe. Iron status is only assessed in half of the patients. In contrast to clinical evidence, iron treatment is underutilised and mainly based on oral iron supplementation. Implementation of guidelines needs to be increased to minimize the use of blood transfusions.
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Affiliation(s)
- Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - M. Aapro
- IMO Clinique de Genolier, Genolier, Switzerland
| | | | - J. Glaspy
- UCLA School of Medicine, Los Angeles, USA
| | | | | | - A. Österborg
- Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | | | - Y. Beguin
- CHU of Liège and University of Liège, Liège, Belgium
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de Mello RA, Gerós S, Alves MP, Moreira F, Avezedo I, Dinis J. Cetuximab plus platinum-based chemotherapy in head and neck squamous cell carcinoma: a retrospective study in a single comprehensive European cancer institution. PLoS One 2014; 9:e86697. [PMID: 24516537 PMCID: PMC3916324 DOI: 10.1371/journal.pone.0086697] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/11/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The use of cetuximab in combination with platinum (P) plus 5-fluorouracil (F) has previously been demonstrated to be effective in the treatment of metastatic squamous cell cancer of head and neck (SCCHN). We investigated the efficacy and outcome of this protocol as a first-line treatment for patients with recurrent or metastatic disease. We evaluated overall-survival (OS), progression-free-survival (PFS), overall response rate (ORR) and the treatment toxicity profile in a retrospective cohort. PATIENTS AND METHODS This study enrolled 121 patients with untreated recurrent or metastatic SCCHN. The patients received PF+ cetuximab every 3 weeks for a maximum of 6 cycles. Patients with stable disease who received PF+ cetuximab continued to receive cetuximab until disease progressed or unacceptable toxic effects were experienced, whichever occurred first. RESULTS The median patient age was 53 (37-78) years. The patient cohort was 86.8% male. The addition of cetuximab to PF in the recurrent or metastatic setting provided an OS of 11 months (Confidential Interval, CI, 95%, 8.684-13.316) and PFS of 8 months (CI 95%, 6.051-9.949). The disease control rate was 48.9%, and the ORR was 23.91%. The most common grade 3 or 4 adverse events in the PF+ cetuximab regimen were febrile neutropenia (5.7%), skin rash (3.8%) and mucosistis (3.8%). CONCLUSIONS The results of this study suggest that cetuximab plus platinum-fluorouracil chemotherapy is a good option for systemic treatment in advanced SSCHN patients. This regimen has a well-tolerated toxicity profile.
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Affiliation(s)
- Ramon Andrade de Mello
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
- Department of Medicine and Biomedical Sciences, School of Medicine, University of Algarve, Faro, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Gerós
- Service of Otorhinolaryngology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
- Department of Otorhinolaryngology and Cervical Facial Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Marcos Pantarotto Alves
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
| | - Filipa Moreira
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Isabel Avezedo
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
| | - José Dinis
- Department of Medical Oncology, Head and Neck Unit, Portuguese Oncology Institute, Porto, Portugal
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