Occurrence and Management of Thrombocytopenia in Metastatic Colorectal Cancer Patients Receiving Chemotherapy: Secondary Analysis of Data From Prospective Clinical Trials

The current study explored the incidence and clinical consequences of chemotherapy-induced thrombocytopenia (CIT) among metastatic colorectal cancer (mCRC) patients. The study revealed that 37% of mCRC patients receiving FOLFOX4 experienced CIT. The most frequent consequence of CIT was a delay in chemotherapy. The present study thus highlights the gap in knowledge and need for improved treatment options in CIT management. Introduction: Chemotherapy-induced thrombocytopenia (CIT) contributes to treatment dose delay and/or modification, often resulting in poorer survival and disease progression. We explored the incidence and clinical consequences of CIT among metastatic colorectal cancer (mCRC) patients. Materials and Methods: Data from two prospective randomized phase 3 trials of mCRC patients receiving either first-line FOLFOX4 (fluorouracil, leucovorin, oxaliplatin) or second-line FOLFIRI (fluorouracil, leucovorin, irinotecan) were analyzed. Thrombocytopenia was defined by platelet count < 100 x 10(9)/L (further categorized by grade) and by recorded adverse events (AEs). Co-occurrence of anemia (hemoglobin < 12 g/dL) and neutropenia (neutrophil count < 2 x 10(9)/L) and clinical consequences of CIT were also evaluated. Results: Among 1078 mCRC patients in the FOLFOX4 study, cumulative incidence of CIT based on platelet count was 37% (grade 3, 2%; grade 4, 1%) during an average 8 months' follow-up. Neutropenia or anemia were absent in 44% of CIT episodes; 62% of CIT AEs led to chemotherapy dose delay, change, and/or discontinuation. Among 1067 mCRC patients in the FOLFIRI study, cumulative incidence of CIT based on platelet count was 4% (grade 3, < 1%; grade 4, 0) during an average 4 months' follow-up. Neutropenia or anemia were absent in 22% of CIT episodes; 32% of CIT AEs led to chemotherapy dose delay, change, and/or discontinuation. With both regimens, transfusions and hospitalizations after CIT AEs were rare (< 3%). Conclusion: CIT was common among mCRC patients receiving the FOLFOX4 regimen. The most frequent consequence of CIT was a delay in chemotherapy, highlighting the unmet need in CIT management. (C) 2020 The Authors. Published by Elsevier Inc.

Automated summary

The study revealed a high incidence of chemotherapy-induced thrombocytopenia (CIT) among mCRC patients, with a significant number experiencing delays in chemotherapy as a consequence. This highlights the need for improved management strategies for CIT in this patient population.