825 Background: Patients with gastrointestinal (GI) cancer often develop anemia due to the disease itself or as a treatment-related adverse event. Anemia is generally treated with oral iron, Red blood cell (RBC) transfusions and erythropoiesis-stimulating agents (ESAs). Ferric carboxymaltose (FCM) is an intravenous iron formulation that enables high-dose administration in a short time and has lower GI toxicity compared to oral iron. This retrospective study evaluated the efficacy and safety of FCM in anemic patients with GI cancer. Methods: We retrospectively analyzed patients with GI cancer and hemoglobin (Hb) levels less than 10 g/dL who received FCM at our institution between October 2022 and February 2025. Each administration of FCM was performed at intervals of at least one week. Baseline Hb levels were collected for all patients, and transferrin saturation (TSAT) was measured where available. TSAT was calculated as: (serum iron / total iron-binding capacity) × 100. Patients were classified as having iron deficiency anemia (IDA) if TSAT was < 20% and as non-IDA if TSAT was ≥ 20%. A Responder was defined as an increase of at least 1 g/dl in Hb without RBC transfusion within 12 weeks from the first administration of FCM. Responders and non-responders were compared between the IDA and non-IDA groups using the χ² test. Results: A total of 92 patients (median age 67 years range: 39–90 years; 54% male) were included. Cancer types included colorectal (26%, n=24), gastric (25%, n=23), biliary (14%, n=13), pancreatic (14%, n=13), esophageal (10%, n=11), small intestinal or duodenal (3%, n=3), anal canal (3%, n=3) and others (3%, n=3). Median baseline Hb level was 8.2 g/dL (IQR: 7.6–8.8). Seventy-six patients (83%) were receiving chemotherapy at the time of their first FCM administration. A total of 28 patients received RBC transfusion within 12 weeks. After FCM treatment, 57% (n=52) of patients were responders, and 41% (n=38) achieved a ≥2 g/dL Hb increase without RBC transfusions within 12 weeks. Among patients without RBC transfusions at 12 weeks, the median Hb level was 10.8 g/dL (IQR: 9.3-11.7).Baseline TSAT was available for 59 patients, of whom 32% (n=19) had IDA and 68% (n=40) had non-IDA. In the IDA group, 58% (n=11) achieved responder, compared with 55% (n=22) in the non-IDA group. There was no significant difference between IDA and non-IDA groups. No adverse events led to discontinuation of FCM therapy. Conclusions: FCM demonstrated clinically meaningful efficacy in improving Hb levels in patients with GI cancer–related anemia, with more than 50% of patients achieving a ≥1g/dL increase without requiring RBC transfusions. The benefit was observed in both IDA and non–IDA groups, and FCM was well tolerated with no treatment discontinuations due to adverse events. These findings support the role of FCM as a safe and effective treatment option for anemia in patients with GI cancer.
Yamada et al. (Sat,) studied this question.