Ivy P. Altomare, MD
Although upfront management of immune thrombocytopenia (ITP) in adults has not changed much over the years, advances in the treatment of refractory ITP have some clinicians looking for guidance. In 2018, the FDA approved fostamatinib (Tavalisse) as a second-line treatment for adults with chronic ITP, making it the first new drug marketed for adults with ITP since approvals of romiplostim (Nplate) and eltrombopag (Promacta) a decade earlier.1-3
The FDA is also considering a request to expand indications for avatrombopag (Doptelet) to include refractory ITP in adults, with a decision expected by June 30, 2019.4
During a recent OncLive Peer Exchange®
discussion, a trio of ITP specialists agreed the anticipated approval of avatrombopag would further complicate decision making. “We don’t have randomized head-to-head trials of any of these modalities to help,” said moderator Ivy P. Altomare, MD. Despite the challenges, the benefit of having more choices for patients is undeniable. Splenectomy and its attendant risks are now often delayed until much later in the disease course.
The panelists reviewed clinical trial data that led to approval of the second-line agents and talked about efforts to refine first-line treatment to prolong responses and minimize adverse effects (AEs). They also discussed how they approach therapy selection for refractory patients. Finally, they highlighted emerging therapies for ITP and the need to expand the pipeline.
“We have some newer agents where it looks like the control of the disease will be significantly longer, and we have a fraction of patients who, once they come off therapy, will maintain their responses, but we still haven’t hit the bullseye yet,” said Ralph V. Boccia, MD.
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