University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
Center for Hematology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA.
Cancer Med. 2024 Aug;13(15):e7429. doi: 10.1002/cam4.7429.
Chemotherapy-induced thrombocytopenia (CIT) is a common challenge of cancer therapy and can lead to chemotherapy dose reduction, delay, and/or discontinuation, affecting relative dose intensity, and possibly adversely impacting cancer care. Besides changing anticancer regimens, standard management of CIT has been limited to platelet transfusions and supportive care. Use of the thrombopoietin receptor agonist romiplostim, already approved for use in immune thrombocytopenia, has shown promising signs of efficacy in CIT. In a phase 2 prospective randomized study of solid tumor patients with platelet counts <100 × 10/L for ≥4 weeks due to CIT, weekly romiplostim corrected the platelet count to >100 × 10/L in 93% (14/15) of patients within 3 weeks versus 12.5% (1/8) of untreated patients (p < 0.001). Including patients treated with romiplostim in an additional single-arm cohort, 85% (44/52) of all romiplostim-treated patients responded with platelet count correction within 3 weeks. Several retrospective studies of CIT have also shown responses to weekly romiplostim, with the largest study finding that poor response to romiplostim was predicted by tumor invasion of the bone marrow (odds ratio, 0.029; 95% CI: 0.0046-0.18; p < 0.001), prior pelvic irradiation (odds ratio, 0.078; 95% CI: 0.0062-0.98; p = 0.048), and prior temozolomide treatment (odds ratio 0.24; 95% CI: 0.061-0.96; p = 0.043). Elsewhere, lower baseline TPO levels were predictive of romiplostim response (p = 0.036). No new safety signals have emerged from romiplostim CIT studies. Recent treatment guidelines, including those from the National Comprehensive Cancer Network, now support consideration of romiplostim use in CIT. Data are expected from two ongoing phase 3 romiplostim CIT trials.
化疗引起的血小板减少症（CIT）是癌症治疗中的常见挑战，可导致化疗剂量减少、延迟和/或停止，影响相对剂量强度，并可能对癌症治疗产生不利影响。除了改变抗癌方案外，CIT 的标准治疗方法仅限于血小板输注和支持性护理。血小板生成素受体激动剂罗米司亭已被批准用于治疗免疫性血小板减少症，在 CIT 的 2 期前瞻性随机研究中，对因 CIT 导致血小板计数<100×10/L 且持续≥4 周的实体瘤患者每周给予罗米司亭治疗，15 例患者中有 93%（14/15）在 3 周内血小板计数纠正至>100×10/L，而未接受治疗的 8 例患者中只有 12.5%（1/8）（p<0.001）。在另一个单臂队列中包括接受罗米司亭治疗的患者，所有接受罗米司亭治疗的患者中有 85%（44/52）在 3 周内血小板计数纠正得到应答。几项 CIT 的回顾性研究也显示了每周给予罗米司亭的反应，最大的研究发现，罗米司亭治疗反应不佳与肿瘤骨髓浸润（比值比，0.029；95%CI：0.0046-0.18；p<0.001）、盆腔放疗史（比值比，0.078；95%CI：0.0062-0.98；p=0.048）和先前替莫唑胺治疗（比值比 0.24；95%CI：0.061-0.96；p=0.043）有关。此外，较低的基线 TPO 水平与罗米司亭反应相关（p=0.036）。罗米司亭 CIT 研究中未出现新的安全性信号。最近的治疗指南，包括国家综合癌症网络的指南，现在支持在 CIT 中考虑使用罗米司亭。两项正在进行的罗米司亭 CIT 3 期试验的数据预计将很快公布。
