Optimal management of chemotherapy-induced thrombocytopenia with thrombopoietin receptor agonists

Treatment of chemotherapy-induced thrombocytopenia with monotherapy versus combination therapy: the devil is in the details

“…Importantly, this complication was not observed in patients treated with rhTPO, which ultimately completed clinical development in China, where it is now approved for CIT and immune thrombocytopenia (ITP) and where its use is recommended to treat CIT in Chinese oncologic treatment guidelines [ 4 ]. Hetrombopag is a newer thrombopoietin receptor agonist with clinical characteristics similar to eltrombopag (has food interactions, potential hepatotoxicity, chelates iron, and dose reduction is recommended in persons of East Asian descent), which is currently approved for ITP and severe aplastic anemia in China (though not yet for CIT) [ 5 , 6 ]. While the specific agents being used in this study are different than what are being employed and studied to treat CIT in the rest of the world (romiplostim and avatrombopag), the overarching concept (combination therapy vs monotherapy) remains relevant.…”

“…When studying CIT and when treating it in the clinic, the first step is always to identify the CIT subtype under evaluation, and there are 2 such phenotypes to consider [ 5 ]. Persistent CIT occurs when a patient presents for day 1 of a chemotherapy cycle with mild to moderate thrombocytopenia (typically 50-100 × 10 9 /L) such that chemotherapy cannot be safely or confidently administered at full dose and on schedule, leading to chemotherapy dose reduction, treatment delay, or regimen discontinuation for an alternative (and usually oncologically inferior) regimen.…”