Avatrombopag switching from other thrombopoietic agents in severe and persistent cancer treatment-induced thrombocytopenia: a multicentre real-world study.

BACKGROUND

Severe and persistent cancer treatment-induced thrombocytopenia (CTIT) remains a major obstacle to continuation of antineoplastic therapy and faces an increased risk of bleeding. Standard therapy has yet to be established in this setting.

OBJECTIVES

This study aimed to evaluate the efficacy of avatrombopag switching from other thrombopoietic agents and baseline factors associated with non-response or early response in severe and persistent CTIT.

METHODS

In this multicentre real-world cohort study, we included 78 patients with solid tumors or non-myeloid hematologic malignancies who showed no response or loss of response to prior thrombopoietic agents and had grade 4 thrombocytopenia for at least 4 weeks. Platelet response and relevant influencing factors, transfusion dependence, interruptions to antineoplastic therapy, and safety were assessed.

RESULTS

Median baseline platelet count was 10 × 109/L and increased to 102 × 109/L after switching to avatrombopag (p < 0.001). Platelet response rates increased over time, from 28.2% at week 4 to 43.6% at week 8 and 52.6% at week 12. The overall difference across these time points was significant (p < 0.001). After switching therapy, platelet transfusion dependence decreased significantly from 69.2% to 19.2% (p < 0.001), along with interruptions to antineoplastic therapy decreased from 88.5 to 50.0% (p < 0.001). The median time to platelet response was 11.7 weeks. Hemoglobin>123 g/L at baseline might be associated with early platelet response. Major bleeding at baseline might independently predicted poor platelet response across different time points. No grade ≥3 adverse events were observed.

CONCLUSION

Switching to avatrombopag was associated with platelet recovery, reduced transfusion dependence, fewer interruptions to antineoplastic therapy, and an acceptable safety profile for severe and persistent CTIT.