Overall survival in mCRC patients with persistent chemotherapy-induced thrombocytopenia

In this video, Prof Hanny Al-Samkari, hematologist and clinical investigator at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School, summarized findings from a poster presented at ASH 2025 examining overall survival (OS) in patients with metastatic colorectal cancer (mCRC) who develop persistent chemotherapy-induced thrombocytopenia (CIT).

While the RECITE trial previously established the safety and efficacy of romiplostim for the management of persistent CIT in patients with gastrointestinal malignancies, it was not designed to assess OS outcomes. The current analysis sought to address this gap by evaluating OS in patients with mCRC who experienced persistent CIT, compared with expected survival outcomes in the broader mCRC population.

This retrospective study used the Flatiron database and included 2,367 patients diagnosed with mCRC between 2011 and 2013 who received FOLFOX, FOLFOXIRI, or CAPOX chemotherapy. Persistent CIT was defined in alignment with RECITE trial criteria as a platelet count ≤85,000/µL on or beyond day 1 of a chemotherapy cycle, despite adequate recovery time (≥13 days for FOLFOX/FOLFOXIRI and ≥20 days for CAPOX).

Median OS among patients with persistent CIT ranged from 9 to 23 months, with 6-month survival probabilities between 64% and 90%. This is notably shorter than contemporary expectations for mCRC survival. These findings highlight the clinical consequences of persistent CIT, including chemotherapy dose reductions or delays that may adversely affect oncologic outcomes. Additional factors influencing survival included ECOG performance status, age, severity of thrombocytopenia, and use of bevacizumab. 

Overall, this analysis reinforces persistent CIT as a significant and underrecognized determinant of survival in mCRC patients and underscores the need for effective CIT-directed therapies beyond traditional chemotherapy modifications.