Use of Intravenous Ferric Carboxymaltose in Treatment of Anemia in Cancer Patients Undergoing Chemotherapy

The study aims to investigate the effect of FCM (without ESAs) on anemic cancer patients undergoing chemotherapy (with or without radiotherapy); stratified by status of iron deficiency (i.e. non-iron deficient vs. iron deficient patients ). The study will also try to find out whether serum level of Hepcidin and C reactive protein can correlate with response

Patients will receive one or two doses of FCM, based on the body weight and Hb level. Patients will be followed-up for a total of twelve weeks. The study is divided into a screening, treatment and follow-up phases and is expected to be completed in 12 months.

Inclusion criteria

• Patient is an adult more than or equal 18 years old at the time of informed consent.
• Patient has pathologic diagnosis of solid tumor (breast cancer, colorectal, lung, sarcoma, head and neck, sarcoma, genitourinary or gynecological cancer).
• Patients who started chemotherapy (with or without radiotherapy) or planned to receive chemotherapy for at least 12 weeks.
• Patient has an Eastern Cooperative Oncology Group performance status between 0 and 2.
• Patient with Hb ≤11 g/dL.
• Patient has a Life expectancy at least 6 months.
• Adequate hepatic and renal function defined as a serum aspartate aminotransferase or alanine aminotransferase level that are no more than 3 times the upper limit of the normal range, a serum bilirubin level that is no more than 2 times the upper limit of the normal range and a serum Creatinine level of less than 2 mg per deciliter.
• Patient is able to understand and provide informed consent to participate in the study.

Exclusion criteria

• Patient has Hb < 8.0 g/dL
• Patient presenting with hematologic malignancy including
• Prior gastric surgery.
• Patients on definitive radiotherapy alone.
• Patients with relevant history (within six weeks) or clinical evidence of hemolysis or active bleeding that could, in the investigator's judgment, be a potential cause for the anemia (no gross hematuria, hemoptysis, hematochezia or melena and negative stool for hemoccult)
• Presence of other nutritional anemia; deficiency of vitamin B12 less than 187 pg/ml and deficiency of Folate less than 3.1 ng/ml according to the local laboratory normal ranges
• Patient has Iron overload (Serum Ferritin more than 800 ng/ml or Transferrin saturation (TSAT) more than 40%)
• Patient is pregnant or lactating.
• Patient has a personal or family history of hemochromatosis.
• Patient has hypersensitivity to any form of IV iron.
• Patient has received red blood cells transfusion or used erythropoietin within 2 weeks of enrollment into the study.
• Patient has received any form of intravenous iron within the last 12 weeks
• Patient has received oral iron supplements within 1 month of enrollment to the study, except for multivitamin supplements containing less than 30 mg iron.