A Single Institutional Experience Using Avatrombopag to Manage Severe and Refractory Treatment Related Thrombocytopenia in Solid Tumor and Hematologic Malignancy Patients

Background:Cancer therapy induced thrombocytopenia (CTIT) is a common complication of systemic treatment for cancer, both in solid tumors and hematologic malignancies. Some patients had persistent severe thrombocytopenia that failed to respond to thrombopoietin receptor (TPO-R) agonists such as eltrombopag, hetrombopag or recombinant human thrombopoietin (rhTPO). Avatrombopag, a second generation TPO-R agonist, has been approved for the treatment of thrombocytopenia in patients with chronic liver disease scheduled to undergo invasive procedures and primary chronic immune thrombocytopenia (ITP). Recent studies testified the effect of avatrombopag in ITP patients not responding to romiplostim and/or eltrombopag. In this study, we share the experience of the off-label use of avatrombopag in the management of CTIT with grade 4 thrombocytopenia, and assessed the efficacy as well as safety of the drug.