Optimal management of chemotherapy-induced thrombocytopenia with thrombopoietin receptor agonists

Blood Rev. 2024 Jan:63:101139. doi: 10.1016/j.blre.2023.101139. Epub 2023 Oct 18.

Abstract

Chemotherapy-induced thrombocytopenia (CIT) is a common complication of antineoplastic therapy, resulting in antineoplastic therapy dose reductions, treatment delays, treatment discontinuation, and morbid bleeding events. Despite several decades of research into thrombopoietic growth factors in CIT, there are presently no available U.S. FDA- or EMA-approved agents to treat CIT. However, a respectable body of evidence has been published evaluating the thrombopoietin receptor agonists (TPO-RAs) for the management and prevention of CIT in patients with solid tumors, and critical studies are ongoing with the TPO-RAs romiplostim and avatrombopag. When employed in the appropriate patient population and used properly, TPO-RAs can successfully and safely manage CIT for extended periods of time with minimal apparent risks. This comprehensive review discusses the evidence for TPO-RAs in CIT in patients with solid tumors, provides detailed guidance for their use in the clinic, and discusses ongoing essential clinical trials in management of CIT.

Keywords: Avatrombopag; Bleeding; Chemotherapy; Chemotherapy-induced thrombocytopenia; Nadir CIT; Persistent CIT; Romiplostim; Supportive care; Thrombocytopenia; Thrombopoietin; Thrombopoietin receptor agonist.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antineoplastic Agents* / adverse effects
  • Humans
  • Neoplasms* / complications
  • Neoplasms* / drug therapy
  • Receptors, Thrombopoietin / agonists
  • Risk
  • Thrombocytopenia* / chemically induced
  • Thrombocytopenia* / drug therapy

Substances

  • Receptors, Thrombopoietin
  • Antineoplastic Agents