SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Pharmacology of Anti-Cancer Drugs
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1549214
This article is part of the Research TopicEvidence-Based Research and Clinical Application of Adverse Reactions and Management Strategies for Cancer Treatment DrugsView all 9 articles
Efficacy and safety of different treatments in chemotherapy-induced thrombocytopenia: a systematic review and network meta-analysis
Provisionally accepted
Huiyan Yang
Xiaoxiao XuMei Tan
Jingyu GaoRuihan FangXuan LiuZhaokun ChenLibai Chen
Yongsheng RuanYiqi XuYaxin Luo
Xuedong Wu*- Nanfang Hospital, Southern Medical University, Guangzhou, China
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Background: Chemotherapy-induced thrombocytopenia (CIT) is a challenge in cancer treatment, increasing bleeding risks and reducing chemotherapy dose. We sought to compare the efficacy and safety of various treatments for CIT.Methods: Randomized clinical trials (RCTs) involving CIT treatments were subjected to a systematic review and network meta-analysis. PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases were searched up to July 2, 2024.Results: Sixteen RCTs (n =1746) were included in this study. Pairwise meta-analysis showed thrombopoietic agents significantly reduced platelet transfusions (OR =0.50; 95% CI: 0.32-0.77), improved nadir platelet count (SMD =0.39; 95% CI: 0.25-0.53) and promoted platelet recovery ≥100×109/L (SMD =-0.48; 95% CI: -0.68 to -0.28). Thrombopoietin receptor agonists (TPO-RAs) reduced chemotherapy delays or dose reductions (OR =0.37; 95% CI: 0.20-0.67) and the incidence of grade 3/4 thrombocytopenia (OR =0.50; 95% CI: 0.27-0.93). Network meta-analysis indicated that eltrombopag ranked first in reducing chemotherapy dose reductions or delays and increasing nadir platelet count. In terms of reducing the incidence of grade 3/4 thrombocytopenia, recombinant human thrombopoietin (rhTPO) ranked highest, followed by eltrombopag. Recombinant human interleukin-11(rhIL-11) had the lowest platelet transfusion rate but the highest incidence of adverse events, whereas avatrombopag had the lowest rate of adverse events and thromboembolism. Additionally, avatrombopag outperformed eltrombopag in promoting hemoglobin and neutrophils recovery.Conclusion: Thrombopoietic agents may benefit CIT patients. TPO-RAs, particularly eltrombopag, show superior efficacy and good tolerability. Although rhIL-11 and rhTPO can rapidly promote platelet recovery and reduce platelet transfusions, they have several limitations.
Keywords: Chemotherapy-induced thrombocytopenia, efficacy, Safety, Network meta-analysis, randomized controlled trials, Thrombopoietic agents
Received: 19 Mar 2025; Accepted: 09 Jul 2025.
Copyright: © 2025 Yang, Xu, Tan, Gao, Fang, Liu, Chen, Chen, Ruan, Xu, Luo and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xuedong Wu, Nanfang Hospital, Southern Medical University, Guangzhou, China
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