Iron Deficiency in Oncology: A Still Overlooked Clinical Challenge

At IMCID 2025, Prof. Sandro Barni highlights the importance of iron supplementation in oncology and the emerging role of iron metabolism in therapeutic pathways.

The ninth edition of the International Multidisciplinary Course on Iron Deficiency (IMCID), held in Palermo, gathered specialists and researchers from around the world to review the most recent scientific evidence on iron deficiency—a condition that affects numerous clinical areas. Among the key contributors to the 2025 scientific program was Prof. Sandro Barni, Director Emeritus of Oncology at ASST BG Ovest – Treviglio Hospital, who participated as a member of the Scientific Committee and chair of the session dedicated to oncology. In this interview, he discusses the increasingly strategic role of iron in oncology practice.

Professor, what makes this edition of IMCID particularly significant compared to previous ones?

I believe this congress is truly unique and has become a reference point for the scientific community. Iron deficiency is a topic that rarely gets space in major medical conferences, whereas here it is addressed in depth and from a multidisciplinary perspective. Today, we finally have a growing body of scientific publications demonstrating the concrete clinical impact of iron deficiency. For too long, this issue has been underestimated. Now, it is at the center of renewed attention, and IMCID is playing a crucial role in highlighting its importance.

Anaemia is a frequent and complex issue in oncology. What are the latest recommendations for managing iron deficiency in this setting?

Anaemia, especially when severe, can prevent the continuation of oncological treatments—particularly systemic therapies, but also radiotherapy, which is highly sensitive to the hypoxia caused by reduced haemoglobin levels. It is therefore essential to prevent and manage this condition promptly.
We know that between 50% and 60% of oncology patients already present with iron deficiency or even overt anaemia at their first visit. This tendency worsens over time due to the toxic effects of chemotherapy, hormone therapy, targeted therapies, immunotherapy, and more recently, ADCs. If iron deficiency and/or anaemia are not corrected, we often have to reduce doses or discontinue treatments, with a negative impact on clinical outcomes.

Can iron metabolism directly influence tumour progression?

That’s a complex question. At the moment, we do not yet have conclusive data to establish a direct causal link. However, it is clear that failing to correct iron deficiency leads to interruptions and dose reductions in treatment, which can in turn worsen disease progression. So, even indirectly, iron metabolism certainly has a significant impact on prognosis.

Are there clinical scenarios in which iron supplementation proves especially decisive?

Yes, and today we have increasingly solid evidence. At this edition of IMCID, for instance, two studies were presented on the use of Sucrosomial® Iron in combination with chemotherapy and chemoradiotherapy. In both cases, supplementation made it possible to maintain stable haemoglobin levels, avoiding treatment interruptions.
This is a clear benefit both for patients and the healthcare system: we reduce the need for transfusions or erythropoiesis-stimulating agents, leading to improved quality of care and better resource optimization.

In today’s oncology landscape, iron is no longer just a laboratory parameter to monitor, but a true therapeutic tool. Prof. Barni’s contribution at IMCID 2025 reaffirmed that managing iron deficiency—and the resulting iron-deficiency anaemia—is a crucial component for ensuring continuity and effectiveness in cancer treatments. A clear message, supported by new evidence, that confirms the value of a multidisciplinary, evidence-based approach in modern medicine.