Romiplostim for chemotherapy – induces thrombocytopenia

Chemotherapy-induced thrombocytopenia (CIT) is a common adverse event associated with systemic oncotherapy. CIT itself can worsen outcome due to bleeding episodes and the necessary reduction in dose intensity of oncological treatment. Currently, dose reduction, delay or discontinuation and platelet transfusion are the standard of care for the management of CIT. However, the concept of using trombopoietin receptor agonists (TPO-RAs) for CIT has emerged in the past 5-10 years. The available evidence supports the use of romiplostim in persistent CIT rather than the use of small-molecule TPO-RAs for the supplementation in nadir CIT or the prophylaxis against low platelet counts. Although the RECITE phase III trial demonstrated the efficacy and safety of romiplostim in persistent CIT among patients treated with oxaliplatin-based protocols, romiplostim has not yet been approved for the treatment of persistent CIT. Guidelines recommend TPO-RAs within the context of clinical trials for patients with persistent CIT. In the absence of such trials, romiplostim may be considered in these clinical situations.