Challenges and Advances in Managing Thrombocytopenic Cancer Patients

Abstract

Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

Pancreatic cancer treatment after FOLFIRINOX: prognostic importance of chemotherapy dose intensity and albumin/globulin ratio in second line

“…Although chemotherapy dose intensity is an element that is tried not to be compromised in adjuvant treatments, the prognostic benefit of providing optimal dose density for metastatic cases is clear. However, optimal dose density may cause fatal complications in patients with low bone marrow reserve (19). At this point, the clinician should not forget that the main goal of advanced chemotherapy is palliation and quality of life support.…”

Romiplostim for chemotherapy‐induced thrombocytopenia: Efficacy and safety of extended use

“… 10 However, there is no approved therapy to treat or prevent chemotherapy‐induced thrombocytopenia (CIT), an important unmet clinical need. 1 , 2 …”

“…Suppression of hematopoiesis is a common adverse effect of chemotherapy and, if severe or protracted, may lead to delay or dose reduction of cancer treatment. 1 , 2 Reduced relative dose intensity of chemotherapy may adversely impact optimal management of the malignancy and may decrease progression‐free and overall survival. 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Granulocyte colony‐stimulating factor (filgrastim and pegfilgrastim) are approved by the US Food and Drug Administration to reduce the incidence of chemotherapy‐induced neutropenia and infection.…”

Special Issue: “The Latest Clinical Advances in Thrombocytopenia”

“…We observe that a number of these papers are already viewed at a high rate and even cited, supporting the value of this article series. For this issue, we acquired one original research article [1] and 13 reviews [2][3][4][5][6][7][8][9][10][11][12][13][14] that are shortly introduced below.…”

“…Leader, Hofstetter, and Spectre provide an overview on the difficult topic of managing thrombocytopenic cancer patients by non-transfusion-based means [12]. Thrombocytopenia in patients with malignant neoplasms may be chemotherapy-induced or related to the malignant disease, e.g., in myelodysplastic syndromes (MDS) or acute leukemia (AML).…”