Lymphoid Disease Clinical Trial
Official title:
Phase IV Randomized Study Evaluating Agents Stimulants Erythropoiesis (ASE) Associated With Ferric Carboxymaltose (Ferinject ®) in Concomitant or Sequential Patients Treated for Cancer and With Anemia Associated With Functional Iron Deficiency
Anemia in patients with cancer is a common problem associated with an impaired quality of
life.
Treatment with erythropoiesis stimulating agents (ESA) allows an increase in hemoglobin
levels in 40-70% of patients and decreased transfusion requirements.
Absolute or functional iron deficiency is also common with about 30% of cancer patients with
all histologies combined iron deficiency and anemia.
Several studies have shown the benefits of the combination of intravenous iron to
erythropoiesis-stimulating agents in improving hemoglobin. However, none of them, to the
investigators knowledge, has not been specifically performed on a population of patients
with functional iron deficiency.
In addition, in clinical practice, this association is not carried out in particular because
there is no dosage or consensus sequence for the administration of iron associated with
ESAs.
- Iron Deficiency and Cancer The literature review therefore presents uncertainties do not
allow the routine application of intravenous iron associated with ESAs. The SOR also
conclude that IV iron is "consider" if iron deficiency.
These uncertainties are the heterogeneity of the study populations, contradictory results
and the use of patterns intravenous iron binding and non-standardized.
The investigators focus in this study in patients with chemotherapy-induced anemia with
functional iron deficiency is a cause of lack of response to ESA. Indeed, patients with true
iron deficiency seems to justify a routine iron supplementation. In contrast, patients
without iron deficiency do not warrant formal way of initiating such treatment (although the
literature is contradictory).
This study aims to evaluate, in patients with chemotherapy-induced anemia and functional
iron deficiency, the efficacy and safety of the combination epoietin zeta + Iron in
concomitant intravenous or sequential.
Because data RCP (Summary of Product Characteristics), ease of use, its safety profile, the
ability to achieve higher doses of iron with a lower frequency and with better adherence,
the ferric carboxymaltose was chosen as an intravenous iron. One specialty is available, the
Ferinject ® (Laboratoires VIFOR Pharma).
The erythropoiesis-stimulating agent chosen in this study is epoietin zeta.
- Hepcidin and iron Hepcidin is a peptide hormone of 25 amino acids produced by the liver
and considered as the central regulator of iron homeostasis in the body.
It works by controlling intestinal iron absorption and iron reuse by the reticuloendothelial
system. Hepcidin acts by preventing the export of iron enterocytes, intestinal site of
absorption of dietary iron, and macrophages, iron recycling site of hemoglobin, by binding
to ferroportin present at the membrane these cells and by inducing its internalization and
degradation.
Accordingly, hepcidin can be considered a hyposidérémiante hormone. The hepcidin rate is
increased by the iron thereby limiting its accumulation and tissue damage associated with
iron overload. Inversely, the rate is reduced hepcidin during increased iron as anemia
needs, hypoxia, pregnancy or other situations of iron deficiency.
Moreover, hepcidin is strongly induced by inflammation. Thus, in pathological situations
such as cancer, high levels of hepcidin explain well enough inflammatory anemia
characterized by anemia, iron retention at storage proteins such as ferritin but also at the
level of the reticuloendothelial system endothelial and a decrease in intestinal iron
absorption.
Despite its importance in the pathophysiology of anemia of inflammation and a fortiori with
iron deficiency anemia functional hepcidin is not measured in clinical routine. There is
not, to the investigators knowledge, prospective data on its blood levels in situations of
iron deficiency anemia in cancer patients functional and data on changes in hepcidin levels
induced by treatment with intravenous iron or with erythropoietin.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment