Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy.
U.O.C. Oncologia Medica, ASUR Area Vasta 1, Ospedale Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy.
Nutrients. 2021 Feb 1;13(2):482. doi: 10.3390/nu13020482.
Cancer is often accompanied by worsening of the patient's iron profile, and the resulting anemia could be a factor that negatively impacts antineoplastic treatment efficacy and patient survival. The first line of therapy is usually based on oral or intravenous iron supplementation; however, many patients remain anemic and do not respond. The key might lie in the pathogenesis of the anemia itself. Cancer-related anemia (CRA) is characterized by a decreased circulating serum iron concentration and transferrin saturation despite ample iron stores, pointing to a more complex problem related to iron homeostatic regulation and additional factors such as chronic inflammatory status. This review explores our current understanding of iron homeostasis in cancer, shedding light on the modulatory role of hepcidin in intestinal iron absorption, iron recycling, mobilization from liver deposits, and inducible regulators by infections and inflammation. The underlying relationship between CRA and systemic low-grade inflammation will be discussed, and an integrated multitarget approach based on nutrition and exercise to improve iron utilization by reducing low-grade inflammation, modulating the immune response, and supporting antioxidant mechanisms will also be proposed. Indeed, a Mediterranean-based diet, nutritional supplements and exercise are suggested as potential individualized strategies and as a complementary approach to conventional CRA therapy.
癌症常伴有患者铁谱恶化，由此导致的贫血可能是影响抗肿瘤治疗效果和患者生存的一个因素。一线治疗通常基于口服或静脉铁补充；然而，许多患者仍存在贫血且无反应。关键可能在于贫血本身的发病机制。癌症相关性贫血（CRA）的特点是尽管铁储存充足，但循环血清铁浓度和转铁蛋白饱和度降低，这表明与铁稳态调节以及感染和炎症等其他因素相关的问题更加复杂。本综述探讨了我们目前对癌症中铁稳态的理解，阐明了铁调素在肠道铁吸收、铁循环利用、从肝脏储存中动员以及由感染和炎症引起的诱导调节剂方面的调节作用。还将讨论 CRA 与全身低度炎症之间的潜在关系，并提出一种基于营养和运动的多靶点综合方法，通过减少低度炎症、调节免疫反应和支持抗氧化机制来改善铁利用。事实上，地中海饮食、营养补充剂和运动被认为是潜在的个体化策略，以及对常规 CRA 治疗的补充方法。
