{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:03:55Z","timestamp":1784811835407,"version":"3.55.0"},"reference-count":18,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"3","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Glob Oncol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>PURPOSE<\/jats:title>\n                    <jats:p>Carica papaya leaf extract (CPLE) is known to increase platelet counts (PCs) in certain infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Patients were randomly assigned in a 2:1 ratio to the CPLE or placebo arm and continued treatment until the PC improved to 75,000 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L or above, a platelet transfusion was required, or upto D+10. The primary outcome was to evaluate whether CPLE improves PC faster compared with placebo in a significant proportion of patients with a modified intention-to-treat protocol.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Between March 2020 and October 2024, 219 patients were randomly assigned, of whom 198 patients (CPLE arm: 129; placebo arm: 69) were analyzed for outcomes. The primary end point with modified intention-to-treat analysis showed a statistically significant increase in PC to \u226575,000 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L in a greater proportion of patients by D+4 compared with placebo (59%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      44%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .042). The primary outcome of increasing PC &gt;75,000 \u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L at D+4 was significantly improved by CPLE (83\/129, 64%\n                      <jats:italic toggle=\"yes\">v<\/jats:italic>\n                      33\/69, 48%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .034) compared with placebo as per protocol analysis. There was no grade 3 or grade 4 treatment-related adverse events associated with CPLE. About 43% of patients in the placebo arm versus 25% of patients in the CPLE arm needed dose reductions or delays in their subsequent chemotherapy treatment for patients with grade 2 chemotherapy-induced thrombocytopenia (CIT) at the baseline (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      0.033) and not significant in grade 3 CIT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>CPLE is a potential therapeutic intervention to improve CIT faster and to a greater extent than placebo in this phase III randomized trial without any safety concerns. It could be potentially used as a secondary prophylaxis to maintain the chemotherapy intensity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/go-25-00386","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T19:59:09Z","timestamp":1773259149000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Carica Papaya Leaf Extract to Improve Chemotherapy-Induced Thrombocytopenia: A Phase III Triple-Blinded, Randomized, Placebo-Controlled, Multicentric Trial"],"prefix":"10.1200","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0067-4748","authenticated-orcid":true,"given":"Vikas","family":"Ostwal","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, 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