MEETING NEWS
Continued from page 9 In results from a phase II , multicenter , single-arm trial presented at the 2018 American Society of Clinical Oncology Annual Meeting , investigators reported that treatment with the thrombopoietin receptor agonist romiplostim allowed more patients to complete maintenance therapy with TMZ , without the need for treatment interruptions or discontinuations .
The investigators , led by Emilie Le Rhun , MD , of the University of Lille in France , enrolled patients with histologically confirmed , newly diagnosed glioblastoma who developed thrombocytopenia after receiving TMZ chemotherapy with or without radiation therapy .
Romiplostim was initiated at least one week after completion of radiation therapy and TMZ , at a starting dose of 750 µ g administered via subcutaneous injection .
Dosing of romiplostim was adjusted throughout the trial , according to weekly platelet count assessments . With the following guidelines for therapy adjustments , if the weekly platelet count was :
• < 100 × 10 9 / L for 2 consecutive weeks , romiplostim should be increased by one dose level ( maximum : 1000 µ g / week )
• 100 to 200 × 10 9 / L , the same dose should be continued
• 200 to 400 × 10 9 / L for two consecutive weeks , romiplostim should be reduced by one dose level ( 500 µ g / week )
• > 400 × 10 9 / L , treatment should be withheld and reinitiated if < 200 × 10 9 / L with one level lower than the last dose
Twenty patients ( median age = 61 years ; range = 33-73 years ) were enrolled between July 2014 and December 2016 . The median platelet count at enrollment was 65 × 10 9 / L ( range = 25 × 10 9 / L to 146 × 10 9 / L ) at initiation of TMZ and / or radiation therapy .
Treatment with romiplostim allowed more patients to complete maintentance therapy with TMZ .
After receiving romiplostim , 12 patients continued on to receive six cycles of maintenance therapy with TMZ , representing a success rate of 60 percent ( the study ’ s primary endpoint ). Twelve patients died during treatment , which translated to a median overall survival of 15.18 months ( range = 3-33 months ).
Nineteen patients experienced at least one adverse event
( AE ), and 11 patients reported at least one severe treatmentrelated AE . Based on these data , the investigators concluded that romiplostim was well tolerated in this setting , adding that the trial was terminated early due to success .
Limitations of the analysis include the study ’ s single-arm design , which reduced the ability to determine the therapy ’ s superiority or inferiority over other similar drugs used in this patient population . In addition , the small number of patients enrolled limits the findings ’ generalizability and clinical relevance .
The authors of this study report financial relationships with Abbvie , Daiichi Sankyo , Amgen , Mundipharma , Bristol-Myers Squibb , Immatics , IPSEN , SERVIER , Roche , Lilly , Merck Serono , MSD , Novocure , Teva , Pfizer , Actelion , Tragara , OGD2 Pharma , and Merck Sharp & Dohme .
REFERENCE
Rhun EL , Devos P , Houillier C , et al . Secondary prophylaxis with romiplostim for temozolomide-induced thrombocytopenia in newly diagnosed glioblastoma . Abstract # 2042 . Presented at the 2018 Annual Meeting of the American Society of Clinical Oncology , June 2 , 2018 ; Chicago , Illinois .
How Do Patient and Physician Attitudes Drive Choices in Antiplatelet Therapy for Thrombocytopenia ?
Patients with a hematologic malignancy and thrombocytopenia typically are treated with antiplatelet drugs , but there is little information to help clinicians balance the potential benefits of this therapy with the risks of bleeding . In a “ choice experiment ” presented at the 23rd Congress of the European Hematology Association , researchers described how physician and patient attributes – in the absence of prospective data or evidencebased guidelines – help shape clinical decision-making .
Results of the study revealed that physicians ’ assessment of bleeding and thrombotic risk “ consistently and logically ” influenced choice of one management strategy over another , according to lead study author Avi Leader , MD , of the Maastricht University Medical Center in the Netherlands .
“ Although this study does not show which management strategy is the optimal approach in managing antiplatelet drugs in these patients , the findings provide physicians with a framework of reasonable decisions by shedding light on current practice ,” Dr . Leader told ASH Clinical News . “ Because there are no patient data in this setting , this ‘ hive knowledge ’ represents the best evidence to guide practice .”
October 2018 13