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: < 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.