Iron supplementation and erythropoiesis-stimulatory agents in the treatment of cancer anemia

Unresponsiveness to erythropoiesis-stimulatory agents (ESA), which occurs in 30% to 50% of patients, is a major limitation to the treatment of chemotherapy-related anemia (CRA). This may be related in part to the dysregulation of iron metabolism, leading to functional iron deficiency. However, the use of iron supplementation during treatment with ESA has not been pursued as rigorously in anemic patients with cancer as it has in patients with chronic kidney disease. In this article, the authors discuss the role of iron supplementation in the setting of CRA in view of recent reports that have addressed this issue.