Romiplostim N01 Plus ATRA for Persistent Isolated Chemotherapy-Induced Thrombocytopenia After Complete Remission of Gynecologic, Breast, or Lung Solid Tumors
Summary
This is a prospective, randomized, open-label, active-controlled study to evaluate the efficacy and safety of Romiplostim N01 plus all-trans retinoic acid (ATRA) compared with Romiplostim N01 alone in adults with persistent isolated chemotherapy-induced thrombocytopenia (PICIT) after complete remission of selected gynecologic, breast, or lung solid tumors, including but not limited to non-small cell lung cancer (NSCLC), ovarian cancer, and breast cancer. Eligible participants will be randomized in a 1:1 ratio to receive Romiplostim N01 plus oral ATRA or Romiplostim N01 alone for 12 weeks, with follow-up through Week 24. The primary outcome is the overall platelet response rate at Week 12, defined as platelet count \>50 x 10\^9/L in at least 2 of the last 3 scheduled platelet assessments up to Week 12. Secondary outcomes include sustained response during Weeks 13 to 24, complete and partial response rates, duration of response, time to response, platelet count changes, platelet transfusion requirements, bleeding events, and safety.
Timeline
- Start
- 2025-12-22
- Primary completion
- 2027-10-31
- Completion
- 2027-12-31
Publications
- Background Rainone M, Kasparian S, Nguyen T, Talwar N, Yuan Y, Mei M, Mortimer JE, Waisman JR, Patel N, Pullarkat V. Thrombopoietin Receptor Agonists for Thrombocytopenia Secondary to HER2-Targeted Antibody Drug Conjugates. Oncologist. 2023 Sep 7;28(9):e843-e846. doi: 10.1093/oncolo/oyad185.
- Background Schweinfurth N, Hohmann S, Deuschle M, Lederbogen F, Schloss P. Valproic acid and all trans retinoic acid differentially induce megakaryopoiesis and platelet-like particle formation from the megakaryoblastic cell line MEG-01. Platelets. 2010;21(8):648-57. doi: 10.3109/09537104.2010.513748. Epub 2010 Oct 13.
- Background Zhu X, Wang Y, Jiang Q, Jiang H, Lu J, Wang Y, Kong Y, Chang Y, Xu L, Peng J, Hou M, Huang X, Zhang X. All-trans retinoic acid protects mesenchymal stem cells from immune thrombocytopenia by regulating the complement-interleukin-1beta loop. Haematologica. 2019 Aug;104(8):1661-1675. doi: 10.3324/haematol.2018.204446. Epub 2019 Jan 24.
- Background Wu YH, Chen HY, Hong WC, Wei CY, Pang JS. Carboplatin-Induced Thrombocytopenia through JAK2 Downregulation, S-Phase Cell Cycle Arrest and Apoptosis in Megakaryocytes. Int J Mol Sci. 2022 Jun 3;23(11):6290. doi: 10.3390/ijms23116290.
- Background Al-Samkari H, Kolb-Sielecki J, Safina SZ, Xue X, Jamieson BD. Avatrombopag for chemotherapy-induced thrombocytopenia in patients with non-haematological malignancies: an international, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Haematol. 2022 Mar;9(3):e179-e189. doi: 10.1016/S2352-3026(22)00001-1.
- Background Wilkins CR, Ortiz J, Gilbert LJ, Yin S, Mones JV, Parameswaran R, Mantha S, Soff GA. Romiplostim for chemotherapy-induced thrombocytopenia: Efficacy and safety of extended use. Res Pract Thromb Haemost. 2022 May 10;6(3):e12701. doi: 10.1002/rth2.12701. eCollection 2022 Mar.
- Background Soff GA, Miao Y, Bendheim G, Batista J, Mones JV, Parameswaran R, Wilkins CR, Devlin SM, Abou-Alfa GK, Cercek A, Kemeny NE, Sarasohn DM, Mantha S. Romiplostim Treatment of Chemotherapy-Induced Thrombocytopenia. J Clin Oncol. 2019 Nov 1;37(31):2892-2898. doi: 10.1200/JCO.18.01931. Epub 2019 Sep 23.
- Background Moufarrij S, O'Cearbhaill RE, Zhou Q, Iasonos A, Mantha S, Zwicker J, Wilkins CR. Use of romiplostim for antineoplastic therapy-induced thrombocytopenia in gynecologic and breast cancers. Gynecol Oncol Rep. 2024 Apr 24;53:101399. doi: 10.1016/j.gore.2024.101399. eCollection 2024 Jun.
- Background Xu Y, Song X, Du F, Zhao Q, Liu L, Ma Z, Lu S. A Randomized Controlled Study of rhTPO and rhIL-11 for the Prophylactic Treatment of Chemotherapy-Induced Thrombocytopenia in Non-Small Cell Lung Cancer. J Cancer. 2018 Nov 25;9(24):4718-4725. doi: 10.7150/jca.26690. eCollection 2018.
- Background Goldberg GL, Gibbon DG, Smith HO, DeVictoria C, Runowicz CD, Burns ER. Clinical impact of chemotherapy-induced thrombocytopenia in patients with gynecologic cancer. J Clin Oncol. 1994 Nov;12(11):2317-20. doi: 10.1200/JCO.1994.12.11.2317.
- Background Adelborg K, Veres K, Horvath-Puho E, Clouser M, Saad H, Sorensen HT. Risk and adverse clinical outcomes of thrombocytopenia among patients with solid tumors-a Danish population-based cohort study. Br J Cancer. 2024 May;130(9):1485-1492. doi: 10.1038/s41416-024-02630-w. Epub 2024 Mar 6.
- Background Shaw JL, Nielson CM, Park JK, Marongiu A, Soff GA. The incidence of thrombocytopenia in adult patients receiving chemotherapy for solid tumors or hematologic malignancies. Eur J Haematol. 2021 May;106(5):662-672. doi: 10.1111/ejh.13595. Epub 2021 Feb 16.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Romiplostim N01 | Peptide | 4 ug/kg | Subcutaneous |
| Subject | Tretinoin | Small molecule | 10 mg | Oral |