{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:13:20Z","timestamp":1788786800057,"version":"build-2803163510"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Severe and persistent cancer treatment-induced thrombocytopenia (CTIT) remains a major obstacle to continuation of antineoplastic therapy and faces an increased risk of bleeding. Standard therapy has yet to be established in this setting.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This study aimed to evaluate the efficacy of avatrombopag switching from other thrombopoietic agents and baseline factors associated with non-response or early response in severe and persistent CTIT.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this multicentre real-world cohort study, we included 78 patients with solid tumors or non-myeloid hematologic malignancies who showed no response or loss of response to prior thrombopoietic agents and had grade 4 thrombocytopenia for at least 4\u202fweeks. Platelet response and relevant influencing factors, transfusion dependence, interruptions to antineoplastic therapy, and safety were assessed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Median baseline platelet count was 10\u202f\u00d7\u202f10\n 9<\/jats:sup>\n \/L and increased to 102\u202f\u00d7\u202f10\n 9<\/jats:sup>\n \/L after switching to avatrombopag (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Platelet response rates increased over time, from 28.2% at week 4 to 43.6% at week 8 and 52.6% at week 12. The overall difference across these time points was significant (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). After switching therapy, platelet transfusion dependence decreased significantly from 69.2% to 19.2% (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), along with interruptions to antineoplastic therapy decreased from 88.5 to 50.0% (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). The median time to platelet response was 11.7\u202fweeks. Hemoglobin&gt;123\u202fg\/L at baseline might be associated with early platelet response. Major bleeding at baseline might independently predicted poor platelet response across different time points. No grade \u22653 adverse events were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Switching to avatrombopag was associated with platelet recovery, reduced transfusion dependence, fewer interruptions to antineoplastic therapy, and an acceptable safety profile for severe and persistent CTIT.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1898479","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:49:09Z","timestamp":1784695749000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Avatrombopag switching from other thrombopoietic agents in severe and persistent cancer treatment-induced thrombocytopenia: a multicentre real-world study"],"prefix":"10.3389","volume":"13","author":[{"given":"Ye","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojing","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingwei","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gynecological Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gege","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]},{"name":"Shandong Key Laboratory of Hematological Diseases and Immune Microenvironment","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Hematological Diseases","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]},{"name":"Shandong Key Laboratory of Hematological Diseases and Immune Microenvironment","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Hematological Diseases","place":["Jinan, Shandong, China"]},{"name":"State Key Laboratory of Discovery and Utilization of Functional Components in Traditional Chinese Medicine, Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Hematology, Qilu Hospital of Shandong University","place":["Jinan, Shandong, China"]},{"name":"Shandong Key Laboratory of Hematological Diseases and Immune Microenvironment","place":["Jinan, Shandong, China"]},{"name":"Shandong Provincial Clinical Research Center for Hematological Diseases","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.3324\/haematol.2021.279512","article-title":"Treatment of chemotherapy-induced thrombocytopenia in patients with non-hematologic malignancies","volume":"107","author":"Kuter","year":"2022","journal-title":"Haematologica"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1111\/ejh.13595","article-title":"The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid Tumors or hematologic malignancies","volume":"106","author":"Shaw","year":"2021","journal-title":"Eur J Haematol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2303","DOI":"10.1182\/blood.V89.7.2303","article-title":"Radiotherapy-associated neutropenia and thrombocytopenia: analysis of risk factors and development of a predictive model","volume":"89","author":"Mac Manus","year":"1997","journal-title":"Blood"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1080\/07357907.2020.1855353","article-title":"Chemo\/radiotherapy-induced bone marrow niche alterations","volume":"39","author":"Rafieemehr","year":"2020","journal-title":"Cancer Investig"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s12672-023-00616-3","article-title":"Chemotherapy-induced thrombocytopenia: literature review","volume":"14","author":"Gao","year":"2023","journal-title":"Discov Oncol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"86","DOI":"10.3322\/caac.21596","article-title":"A review of cancer immunotherapy toxicity","volume":"70","author":"Kennedy","year":"2020","journal-title":"CA Cancer J Clin"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.ygyno.2018.01.010","article-title":"Management of the toxicities of common targeted therapeutics for gynecologic cancers","volume":"148","author":"Gunderson","year":"2018","journal-title":"Gynecol Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e179","DOI":"10.1016\/S2352-3026(22)00001-1","article-title":"Avatrombopag for chemotherapy-induced thrombocytopenia in patients with non-haematological malignancies: an international, randomised, double-blind, placebo-controlled, phase 3 trial","volume":"9","author":"Al-Samkari","year":"2022","journal-title":"Lancet Haematol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1080\/17474086.2021.1924053","article-title":"Clinical challenges and promising therapies for chemotherapy-induced thrombocytopenia","volume":"14","author":"Al-Samkari","year":"2021","journal-title":"Expert Rev Hematol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2416","DOI":"10.1016\/j.clinthera.2009.11.020","article-title":"Anemia and thrombocytopenia in patients undergoing chemotherapy for solid Tumors: a descriptive study of a large outpatient oncology practice database, 2000-2007","volume":"31","author":"Wu","year":"2009","journal-title":"Clin Ther"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1056\/NEJMoa1910962","article-title":"Niraparib in patients with newly diagnosed advanced ovarian cancer","volume":"381","author":"Gonzalez-Martin","year":"2019","journal-title":"N Engl J Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3594","DOI":"10.1182\/blood.2020009016","article-title":"Hematologic complications of immune checkpoint inhibitors","volume":"139","author":"Kroll","year":"2022","journal-title":"Blood"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.jtha.2023.09.031","article-title":"Management of chemotherapy-induced thrombocytopenia: guidance from the Isth subcommittee on hemostasis and malignancy","volume":"22","author":"Soff","year":"2024","journal-title":"J Thromb Haemost"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"S63","DOI":"10.1016\/S0049-3848(14)50011-4","article-title":"Thrombocytopenia in Cancer patients","volume":"133","author":"Liebman","year":"2014","journal-title":"Thromb Res"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1038\/369533a0","article-title":"Stimulation of megakaryocytopoiesis and thrombopoiesis by the C-Mpl ligand","volume":"369","author":"de Sauvage","year":"1994","journal-title":"Nature"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1007\/s40265-021-01553-7","article-title":"Thrombopoietin receptor agonists (Tpo-Ras): drug class considerations for pharmacists","volume":"81","author":"Gilreath","year":"2021","journal-title":"Drugs"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1080\/17474086.2023.2201428","article-title":"Emerging data on thrombopoietin receptor agonists for Management of Chemotherapy-Induced Thrombocytopenia","volume":"16","author":"Song","year":"2023","journal-title":"Expert Rev Hematol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.3324\/haematol.2020.251900","article-title":"A Multicenter study of romiplostim for chemotherapy-induced thrombocytopenia in solid Tumors and hematologic malignancies","volume":"106","author":"Al-Samkari","year":"2021","journal-title":"Haematologica"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1056\/NEJMoa2511882","article-title":"Romiplostim versus placebo for chemotherapy-induced thrombocytopenia","volume":"394","author":"Al-Samkari","year":"2026","journal-title":"N Engl J Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"970978","DOI":"10.3389\/fphar.2022.970978","article-title":"Avatrombopag for the treatment of thrombocytopenia induced by chemotherapy in patients with solid tumors: a multicenter, open-label, single-arm trial","volume":"13","author":"Cui","year":"2022","journal-title":"Front Pharmacol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1080\/09537104.2022.2026910","article-title":"Effect of Avatrombopag in the Management of Severe and Refractory Chemotherapy-Induced Thrombocytopenia (Cit) in patients with solid Tumors","volume":"33","author":"Gao","year":"2022","journal-title":"Platelets"},{"key":"ref22","year":"2026"},{"key":"ref23","year":"2017"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of Antihemostatic medicinal products in non-surgical patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.1111\/jth.13140","article-title":"Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the Ssc of the Isth","volume":"13","author":"Kaatz","year":"2015","journal-title":"J Thromb Haemost"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1146\/annurev.med.60.042307.181154","article-title":"Thrombopoietin and thrombopoietin mimetics in the treatment of thrombocytopenia","volume":"60","author":"Kuter","year":"2009","journal-title":"Annu Rev Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1053\/j.gastro.2018.05.025","article-title":"Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia","volume":"155","author":"Terrault","year":"2018","journal-title":"Gastroenterology"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1111\/bjh.19797","article-title":"Avatrombopag for the treatment of patients with chemotherapy-induced thrombocytopenia: a case series","volume":"206","author":"Galamaga","year":"2025","journal-title":"Br J Haematol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1950","DOI":"10.1182\/blood.V92.6.1950.418k21_1950_1956","article-title":"Granulocyte colony-stimulating factor enhances bone marrow stem cell damage caused by repeated administration of cytotoxic agents","volume":"92","author":"van Os","year":"1998","journal-title":"Blood"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"35","DOI":"10.4161\/cc.5.1.2280","article-title":"Hematopoietic stem cell senescence and long-term bone marrow injury","volume":"5","author":"Wang","year":"2006","journal-title":"Cell Cycle"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1365-3148.1992.tb00175.x","article-title":"Guidelines for platelet transfusions. British Committee for Standards in haematology, working Party of the Blood Transfusion Task Force","volume":"2","author":"Murphy","year":"1992","journal-title":"Transfus Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1200\/JCO.2017.76.1734","article-title":"Platelet transfusion for patients with cancer: American Society of Clinical Oncology clinical practice guideline update","volume":"36","author":"Schiffer","year":"2017","journal-title":"J Clin Oncol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1016\/j.exphem.2008.04.020","article-title":"Akr-501 (Ym477) in combination with thrombopoietin enhances human Megakaryocytopoiesis","volume":"36","author":"Fukushima-Shintani","year":"2008","journal-title":"Exp Hematol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1111\/j.1600-0609.2008.01198.x","article-title":"Akr-501 (Ym477) a novel orally-active thrombopoietin receptor agonist","volume":"82","author":"Fukushima-Shintani","year":"2009","journal-title":"Eur J Haematol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"5027","DOI":"10.1007\/s00277-025-06567-9","article-title":"Multicenter, real-world observational study of ava therapy following Elt\/Het switching in Chinese children with persistent\/chronic primary Itp","volume":"104","author":"Liu","year":"2025","journal-title":"Ann Hematol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/bjh.18081","article-title":"Adults with immune thrombocytopenia who switched to avatrombopag following prior treatment with eltrombopag or romiplostim: a multicentre us study","volume":"197","author":"Al-Samkari","year":"2022","journal-title":"Br J Haematol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"313","DOI":"10.2147\/JBM.S191790","article-title":"Avatrombopag for the treatment of immune thrombocytopenia and thrombocytopenia of chronic liver disease","volume":"10","author":"Cheloff","year":"2019","journal-title":"J Blood Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"100909","DOI":"10.1016\/j.blre.2021.100909","article-title":"The structure, function, and clinical use of the thrombopoietin receptor agonist Avatrombopag","volume":"53","author":"Kuter","year":"2022","journal-title":"Blood Rev"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.3324\/haematol.2018.212845","article-title":"Thrombopoietin receptor agonists: ten years later","volume":"104","author":"Ghanima","year":"2019","journal-title":"Haematologica"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2243","DOI":"10.2147\/DDDT.S299591","article-title":"A review of romiplostim mechanism of action and clinical applicability","volume":"15","author":"Bussel","year":"2021","journal-title":"Drug Des Devel Ther"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.ejphar.2010.09.072","article-title":"Pharmacological profile of As1670542, a novel orally-active human thrombopoietin receptor agonist","volume":"650","author":"Abe","year":"2011","journal-title":"Eur J Pharmacol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1334","DOI":"10.1002\/cncr.25714","article-title":"Venous thromboembolism in the patient with Cancer: focus on burden of disease and benefits of thromboprophylaxis","volume":"117","author":"Lyman","year":"2010","journal-title":"Cancer"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1055\/s-0040-1708481","article-title":"A meta-analysis of case fatality rates of recurrent venous thromboembolism and major bleeding in patients with cancer","volume":"120","author":"Abdulla","year":"2020","journal-title":"Thromb Haemost"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1093\/eurheartj\/ehab171","article-title":"Relative risk of arterial and venous thromboembolism in persons with cancer vs. persons without cancer-a nationwide analysis","volume":"42","author":"Grilz","year":"2021","journal-title":"Eur Heart J"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1038\/s41568-023-00639-6","article-title":"The dynamic role of platelets in Cancer progression and their therapeutic implications","volume":"24","author":"Li","year":"2024","journal-title":"Nat Rev Cancer"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e405","DOI":"10.3399\/bjgp17X691109","article-title":"Clinical relevance of thrombocytosis in primary care: a prospective cohort study of Cancer incidence using English electronic medical records and Cancer registry data","volume":"67","author":"Bailey","year":"2017","journal-title":"Br J Gen Pract"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1898479\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:49:19Z","timestamp":1784695759000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1898479\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":46,"alternative-id":["10.3389\/fmed.2026.1898479"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1898479","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"article-number":"1898479"}}