Risk of thrombocytopenia in selected systemic treatments for solid cancers
| Cancer type . | VTE incidence rate/100 PYa . | Selected systemic therapy . | Thrombocytopenia (any grade)b . | Severe thrombocytopenia (grades 3-4)b . | Reference . |
|---|---|---|---|---|---|
| Breast | 1.5/100 PY | Doxorubicin + cyclophosphamide + docetaxel/paclitaxel (adjuvant) | / | <0.5% | Sparano et al, NEJM 2008 |
| Epirubicin + cyclophosphamide followed by docetaxel (neoadjuvant) | / | 1.6% | von Minckwitz G et al, NEJM 2012 | ||
| Paclitaxel (palliative) | / | 0.3% | Miller et al., NEJM 2007 | ||
| Platinum-based neoadjuvant chemotherapy in TNBC | / | 9.6% | Li et al, J Int Med Res 2020 | ||
| CDK4/6 inhibitors | 18.4% | 2.1% | Kassem et al, Breast Cancer 2018 | ||
| Capecitabine | 8.5%-13.9% | 2.4%-2.6% | Nishijima et al, Breast Cancer Res Treat 2016 | ||
| Trastuzumab deruxtecan (advanced Her2-low) | 23.7% | 9.3% | Modi et al, NEJM 2022 | ||
| Trastuzumab deruxtecan vs trastuzumab emtansine (Her2-pos) | 24.9% vs 51.7% | 7.0% vs 24.9% | Cortés et al, NEJM 2022 | ||
| Prostate | 4.2/100 PY | Docetaxel (metastatic; + androgen-deprivation therapy) | / | 0.3% | Sweeney et al, NEJM 2015 |
| Cabazitaxel (mCRPC, pretreated) | 40.8% | 3.2% | De Wit et al, NEJM 2019 | ||
| PARP-inhibitors (mCRPC) | 14.3% | 8.0% | Maiorano et al, Targ Onc 2024 | ||
| NSCLC | 9.5/100 PY | Pemetrexed + platin + pembrolizumab (NSCLC, nonsquamous, palliative) | 18.0% | 7.9% | Gandhi et al, NEJM 2018 |
| Carboplatin + paclitaxel/ nab-paclitaxel + pembrolizumab (NSCLC, squamous, palliative) | 30.6% | 6.8% | Paz-Ares et al, NEJM 2018 | ||
| Cisplatin-based chemotherapy + pembrolizumab (perioperative) | 18.7% | 5.1% | Wakalee et al, NEJM 2023 | ||
| SCLC | 5.9/100 PY | Carboplatin + etoposide + atezolizumab (SCLC, palliative, extensive disease) | 16.2% | 10.1% | Horn et al., NEJM 2018 |
| Colorectal | Colon 7.4/100 PY Rectum 5.8/100 PY | FOLFOX (6 mo, adjuvant, stage III) | / | 1.8% | Grothey et al, NEJM 2018 |
| XELOX (metastatic, pooled from 7 trials) | / | 5.8% | Guo et al, Cancer Invest 2016 | ||
| FOLFOX (metastatic, pooled from 7 trials) | / | 3.2% | Guo et al, Cancer Invest 2016 | ||
| Pancreatic | 17.3/100 PY | FOLFIRINOX (adjuvant) | 47.0% | 1.3% | Conroy et al, NEJM 2018 |
| Gemcitabine (adjuvant) | 50.4% | 5.7% | Conroy et al, NEJM 2018 | ||
| FOLFIRINOX (palliative) | / | 9.1% | Conroy et al, NEJM 2011 | ||
| Gemcitabine + nab- paclitaxel (palliative) | / | 12.8% | Von Hoff et al, NEJM 2013 | ||
| Gastroesophageal | Gastric 8.9/100 PY Esophageal 7.8/100 PY | Triplet chemotherapy (ECF, ECX, EOF, EOX; palliative) | 13.4%-21.1% | 4.3%-5.2% | Cunningham et al, NEJM 2008 |
| Renal cell | 8.9/100 PY | Pembrolizumab + axitinib | 2.6% | 0% | Rini et al, NEJM 2019 |
| Sunitinib | 18%-23.3% | 5%-5.9% | Rini et al, NEJM 2019 | ||
| Nivolumab + ipililumab | <1% | 0% | Motzer et al, NEJM 2018 | ||
| Biliary tract | 12.9/100 PY | Cisplatin + gemcitabine + durvalumab (palliative) | 12.7% | 4.7% | Oh et al, NEJM Evidence 2022 |
| Ovarian | 7.7/100 PY | Paclitaxel + Carboplatin /+ bevacizumab (palliative, stage III, IV) | 9%-12% | 2%-3% | Perren et al, NEJM 2011 |
| Brain | 8.2/100 PY | Temozolomide (newly diagnosed, + radiotherapy) | / | 12% | Stupp et al, NEJM 2005 |
| Sarcoma | NR | Doxorubicin (metastatic soft-tissue sarcoma) | / | <1% | Judson et al, Lancet Onc 2014 |
| Doxorubicin + ifosfamide (metastatic soft-tissue sarcoma) | / | 33% | Judson et al, Lancet Onc 2014 | ||
| Bladder | 9.8/100 PY | Enfortumab vedotin + pembrolizumab vs platin-based chemotherapy | 3.4% vs 34.2% | 0.5% vs 19.4% | Powles et al, NEJM 2024 |
| Cancer type . | VTE incidence rate/100 PYa . | Selected systemic therapy . | Thrombocytopenia (any grade)b . | Severe thrombocytopenia (grades 3-4)b . | Reference . |
|---|---|---|---|---|---|
| Breast | 1.5/100 PY | Doxorubicin + cyclophosphamide + docetaxel/paclitaxel (adjuvant) | / | <0.5% | Sparano et al, NEJM 2008 |
| Epirubicin + cyclophosphamide followed by docetaxel (neoadjuvant) | / | 1.6% | von Minckwitz G et al, NEJM 2012 | ||
| Paclitaxel (palliative) | / | 0.3% | Miller et al., NEJM 2007 | ||
| Platinum-based neoadjuvant chemotherapy in TNBC | / | 9.6% | Li et al, J Int Med Res 2020 | ||
| CDK4/6 inhibitors | 18.4% | 2.1% | Kassem et al, Breast Cancer 2018 | ||
| Capecitabine | 8.5%-13.9% | 2.4%-2.6% | Nishijima et al, Breast Cancer Res Treat 2016 | ||
| Trastuzumab deruxtecan (advanced Her2-low) | 23.7% | 9.3% | Modi et al, NEJM 2022 | ||
| Trastuzumab deruxtecan vs trastuzumab emtansine (Her2-pos) | 24.9% vs 51.7% | 7.0% vs 24.9% | Cortés et al, NEJM 2022 | ||
| Prostate | 4.2/100 PY | Docetaxel (metastatic; + androgen-deprivation therapy) | / | 0.3% | Sweeney et al, NEJM 2015 |
| Cabazitaxel (mCRPC, pretreated) | 40.8% | 3.2% | De Wit et al, NEJM 2019 | ||
| PARP-inhibitors (mCRPC) | 14.3% | 8.0% | Maiorano et al, Targ Onc 2024 | ||
| NSCLC | 9.5/100 PY | Pemetrexed + platin + pembrolizumab (NSCLC, nonsquamous, palliative) | 18.0% | 7.9% | Gandhi et al, NEJM 2018 |
| Carboplatin + paclitaxel/ nab-paclitaxel + pembrolizumab (NSCLC, squamous, palliative) | 30.6% | 6.8% | Paz-Ares et al, NEJM 2018 | ||
| Cisplatin-based chemotherapy + pembrolizumab (perioperative) | 18.7% | 5.1% | Wakalee et al, NEJM 2023 | ||
| SCLC | 5.9/100 PY | Carboplatin + etoposide + atezolizumab (SCLC, palliative, extensive disease) | 16.2% | 10.1% | Horn et al., NEJM 2018 |
| Colorectal | Colon 7.4/100 PY Rectum 5.8/100 PY | FOLFOX (6 mo, adjuvant, stage III) | / | 1.8% | Grothey et al, NEJM 2018 |
| XELOX (metastatic, pooled from 7 trials) | / | 5.8% | Guo et al, Cancer Invest 2016 | ||
| FOLFOX (metastatic, pooled from 7 trials) | / | 3.2% | Guo et al, Cancer Invest 2016 | ||
| Pancreatic | 17.3/100 PY | FOLFIRINOX (adjuvant) | 47.0% | 1.3% | Conroy et al, NEJM 2018 |
| Gemcitabine (adjuvant) | 50.4% | 5.7% | Conroy et al, NEJM 2018 | ||
| FOLFIRINOX (palliative) | / | 9.1% | Conroy et al, NEJM 2011 | ||
| Gemcitabine + nab- paclitaxel (palliative) | / | 12.8% | Von Hoff et al, NEJM 2013 | ||
| Gastroesophageal | Gastric 8.9/100 PY Esophageal 7.8/100 PY | Triplet chemotherapy (ECF, ECX, EOF, EOX; palliative) | 13.4%-21.1% | 4.3%-5.2% | Cunningham et al, NEJM 2008 |
| Renal cell | 8.9/100 PY | Pembrolizumab + axitinib | 2.6% | 0% | Rini et al, NEJM 2019 |
| Sunitinib | 18%-23.3% | 5%-5.9% | Rini et al, NEJM 2019 | ||
| Nivolumab + ipililumab | <1% | 0% | Motzer et al, NEJM 2018 | ||
| Biliary tract | 12.9/100 PY | Cisplatin + gemcitabine + durvalumab (palliative) | 12.7% | 4.7% | Oh et al, NEJM Evidence 2022 |
| Ovarian | 7.7/100 PY | Paclitaxel + Carboplatin /+ bevacizumab (palliative, stage III, IV) | 9%-12% | 2%-3% | Perren et al, NEJM 2011 |
| Brain | 8.2/100 PY | Temozolomide (newly diagnosed, + radiotherapy) | / | 12% | Stupp et al, NEJM 2005 |
| Sarcoma | NR | Doxorubicin (metastatic soft-tissue sarcoma) | / | <1% | Judson et al, Lancet Onc 2014 |
| Doxorubicin + ifosfamide (metastatic soft-tissue sarcoma) | / | 33% | Judson et al, Lancet Onc 2014 | ||
| Bladder | 9.8/100 PY | Enfortumab vedotin + pembrolizumab vs platin-based chemotherapy | 3.4% vs 34.2% | 0.5% vs 19.4% | Powles et al, NEJM 2024 |
Contemporary VTE estimates within 1 year after cancer diagnosis in patients who received chemotherapy or targeted therapy within 4 months following diagnosis.
Thrombocytopenia categorized according to the Common Terminology Criteria for Adverse Events of the National Cancer Institute: grade 1: 75-150 G/L, grade 2: 50-75 G/L, grade 3: 25-50 G/L, grade 4: <25 G/L.
Glioblastoma overall.
Adapted with permission from Mulder et al.12
ECF, epirubicin, cisplatin, 5-flourouracil; ECX, epirubicin, cisplatin, capecitabine; EOF, epirubicin, oxaliplatin, 5-flourouracil; EOX, epirubicin, oxaliplatin, capecitabine; FOLFIRINOX, folinic acid (leucovorin), 5-flourouracil, irinotecan, oxaliplatin; FOLFOX, folinic acid (leucovorin), 5-flourouracil, oxaliplatin; Her2, human epidermal growth factor receptor 2; mCRPC, metastatic castration-resistant prostate cancer; NHL, non-Hodgkin's lymphoma; PARP, poly (ADP-ribose) polymerase; PY, patient-years; SCLC, small cell lung cancer; TNBC, triple-negative breast cancer; XELOX, capecitabine, oxaliplatin.