Peculiarities of iron metabolism in patients with breast cancer before adjuvant chemotherapy

Abstract

Introduction. Numerous studies using multivariate analysis have confirmed the relationship between low hemoglobin and / or hypoxia of tumor tissue with a worsening prognosis.The study objective was to assess the state of iron metabolism in breast cancer patients in the perioperative period, before conducting adjuvant chemotherapy for adequate administration of iron and recombinant erythropoietins preparations.Materials and methods. The object of the study included 17 breast cancer patients with a relatively favorable prognosis, with luminal types A and B (Her 2 / neu positive or negative), three times negative type. The examination was carried out in the postoperative period, before the first course of adjuvant chemotherapy. The main metabolites of ferrokinetics were studied: hepcidin 25 (GP25), ferritin, soluble transferrin receptors, transferin, iron, erythropoietin, C-reactive protein and interleukin 6 indicators.Results. In patients with breast cancer, even before adjuvant chemotherapy, a violation of iron metabolism was revealed. Anemic syndrome (AS) with iron deficiency erythroproiesis was diagnosed in 29.4 % of them. In most of them, AS was accompanied by a deficiency of endogenous erythropoietin. Iron deficiency anemia was more common; functional iron deficiency (FID) was found in some patients. In contrast to patients with iron deficiency anemia, patients with FID had a significant concentrations of GP25, C-reactive protein, and interleukin 6 and ferritin were within the upper limit of normal. It should be noted that GP25 hyperexression was observed not only in breast cancer patients with FID, but also in patients without laboratory signs of anemia, which did not exclude the latent stage of AS.Conclusion. To achieve the effectiveness of the treatment of AS, a comprehensive and personalized approach is required. Iron preparations are prescribed to restore iron metabolism; recombinant erythropoietins preparations are used to increase the rate of erythrocyte formation during chemotherapy. The same treatment regimen is justified for the correction of AS with FID. However, the strategy for future treatment of FID is associated with the use of GP25 antagonists (in order to overcome the retention of iron in the reticuloendothelial system), hormones or cytokines that can effectively stimulate erythropoiesis in AS with impaired iron metabolism.