OBJECTIVES

Thrombocytopenia is a common, potentially treatment-limiting hematologic side effect in cancer treatment.¹ This is particularly true for female genitourinary (fGU) cancers, such as ovarian and endometrial, where treatment involves agents such as platinum-based agents, taxanes, PARP inhibitors, and gemcitabine.^2-6 Evidence has shown that dose reduction can be an effective way to address thrombocytopenia and avoid discontinuation of treatment.^2,3 In this study, we explore the use of RWD to understand real-world rates of thrombocytopenia in fGU cancer, including rates of occurrence, management and impacts on chemotherapy treatment, dose reduction, and discontinuation.

METHODS Analyses were conducted on nationally representative insurance claims database and Electronic Medical Records (EMR). Inclusion criteria of adult fGU cancer patients with prior exposures to gemcitabine, platinum-based agents, taxanes, or PARP. Treatment-emergent thrombocytopenia post-treatment was identified using ICD codes. Baseline descriptive characteristics and dosing changes were assessed. Results were also stratified for the top 2 fGU malignancies, ovarian and endometrial cancer (approximately two-fifths and one-third respectively). Factors associated with thrombocytopenia were assessed using logistic regression modeling and ensemble predictive model approaches. Regression covariates included demographics, medical conditions, treatments and lab tests. Model performance was assessed using Receiver-Operating Characteristic (ROC) scores.

RESULTS Thrombocytopenia incidence was 10-15%, with approximately 6% of cases diagnosed within the first 60 days of therapy. Early onset of thrombocytopenia (within 30 days of initiating therapy) occurred in less than 5% of patients and increased to 13% after more than 90 days. A significant proportion of TCP patients discontinued treatment, with relatively few showing chemotherapy dose reduction. Among TCP patients, approximately 15% received corticosteroids and less than 10% required platelet transfusion. Factors associated with TCP included age, history of arterial disease, and concomitant GI malignancy.

CONCLUSIONS For fGU patients there is an opportunity to anticipate and improve management of thrombocytopenia to enable patients to remain on chemotherapy.