Drug-induced thrombocytopenia in a patient with colorectal cancer: A case report

Pasquariello,Stefano; Clavarezza,Matteo; Piredda,Sabrina; Foppiani,Luca; Pesce,Giampaola; Antonucci,Giancarlo; De Censi,Andrea; Mattioli,Francesca

doi:10.3892/ol.2023.13984

September-2023 Volume 26 Issue 3

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September-2023 Volume 26 Issue 3

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Case Report

Drug-induced thrombocytopenia in a patient with colorectal cancer: A case report

Authors:
- Stefano Pasquariello
- Matteo Clavarezza
- Sabrina Piredda
- Luca Foppiani
- Giampaola Pesce
- Giancarlo Antonucci
- Andrea De Censi
- Francesca Mattioli
View Affiliations / Copyright

Affiliations: Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, I-16132 Genoa, Italy, Medical Oncology Unit, E.O. Ospedali Galliera, I-16128 Genoa, Italy, Internal Medicine Unit, E.O. Ospedali Galliera, I-16128 Genoa, Italy, Department of Internal Medicine, Immunology Unit, University of Genoa, I-16132 Genoa, Italy
Article Number: 398
|
Published online on: July 28, 2023

https://doi.org/10.3892/ol.2023.13984
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Abstract

Drug-induced thrombocytopenia is an adverse reaction characterized by accelerated platelet destruction. The present study described a case of thrombocytopenia that occurred during treatment with panitumumab. A female patient aged 49 years with metastatic rectal adenocarcinoma was treated with 9 out of 12 cycles of therapy with the standard of care, 5-fluorouacil (5-FU), oxaliplatin and folic acid, in association with panitumumab. During cycle 10, the patient developed severe thrombocytopenia, so the therapy was adjusted to a lower dosage; however, during cycle 11, after administration of panitumumab and before administration of 5-FU or oxaliplatin, the patient again presented with severe thrombocytopenia, with a platelet count <2x10⁹/l. Immunology test results were negative apart from anti-nucleus antibodies (titration, 1:160). Naranjo's algorithm was used to establish the relationship between the use of panitumumab and thrombocytopenia onset and a score of 6 (‘probable’) was found. The temporal link between the onset of symptoms and administration of therapy, the relapse of thrombocytopenia after re-administration of the drug during cycle 11 (positive rechallenge) and Naranjo score of 6 (‘probable’) are crucial elements for establishing the causal relationship and the probability that thrombocytopenia was related to the administration of panitumumab. The patient then underwent two cycles of therapy with 5-FU, folic acid and irinotecan, in association with bevacizumab, experiencing again the same adverse event. Treatment with monoclonal antibodies was suspended altogether in favor of a switch to trifluridine/tipiracil. No other serious adverse events were reported.

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1	Barreto JN, McCullough KB, Ice LL and Smith JA: Antineoplastic agents and the associated myelosuppressive effects: A review. J Pharm Pract. 27:440–446. 2014. View Article : Google Scholar : PubMed/NCBI
2	Jardim DL, Rodrigues CA, Novis YAS, Rocha VG and Hoff PM: Oxaliplatin-related thrombocytopenia. Ann Oncol. 23:1937–1942. 2012. View Article : Google Scholar : PubMed/NCBI
3	Erdem GU, Dogan M, Demirci NS and Zengin N: Oxaliplatin-induced acute thrombocytopenia. J Cancer Res Ther. 12:509–514. 2016. View Article : Google Scholar : PubMed/NCBI
4	Danese E, Montagnana M, Favaloro EJ and Lippi G: Drug-induced thrombocytopenia: Mechanisms and laboratory diagnostics. Semin Thromb Hemost. 46:264–274. 2020. View Article : Google Scholar : PubMed/NCBI
5	Marini I, Uzun G, Jamal K and Bakchoul T: Treatment of drug-induced immune thrombocytopenias. Haematologica. 107:1264–1277. 2022. View Article : Google Scholar : PubMed/NCBI
6	US Department of Health and Human Services, . National institutes of health, national cancer institute. Common terminology criteria for adverse events (CTCAE) version 5.0. Published:. November 27–2007.
7	Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C and Greenblatt DJ: A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 30:239–245. 1981. View Article : Google Scholar : PubMed/NCBI
8	Vayne C, Guéry EA, Rollin J, Baglo T, Petermann R and Gruel Y: Pathophysiology and diagnosis of drug-induced immune thrombocytopenia. J Clin Med. 9:22122020. View Article : Google Scholar : PubMed/NCBI
9	VECTIBIX^® (panitumumab) SmPC. Amgen Europe B.V.; Breda: 2022, https://www.ema.europa.eu/en/medicines/human/EPAR/vectibix
10	The European Medicines Agency, . EudraVigilance-European database of suspected adverse drug reaction reports. http://www.adrreports.eu/index.html
11	Kato K, Michishita Y, Oyama K, Hatano Y, Nozawa T, Ishibashi M, Konda R and Sasaki A: A case of thrombotic thrombocytopenic purpura in a patient undergoing FOLFOX6 plus panitumumab therapy for unresectable recurrent rectal cancer with a rapidly progressive course. Gan To Kagaku Ryoho. 43:133–136. 2016.(In Japanese). PubMed/NCBI
12	Dior M, Coriat R, Mir O, Brezault C, Perkins G, Dhooge M, Goldwasser F and Chaussade S: A rare hematological adverse event induced by bevacizumab: Severe thrombocytopenia. Am J Med. 125:828–830. 2012. View Article : Google Scholar : PubMed/NCBI
13	Kumar J, Bhargava M and Aggarwal S: Bevacizumab-induced reversible thrombocytopenia in a patient with adenocarcinoma of colon: Rare adverse effect of bevacizumab. Case Rep Oncol Med. 2012:6954302012.PubMed/NCBI
14	Leal T and Robins HI: Bevacizumab induced reversible thrombocytopenia in a patient with recurrent high-grade glioma: A case report. Cancer Chemother Pharmacol. 65:399–401. 2010. View Article : Google Scholar : PubMed/NCBI
15	Meyer T, Robles-Carrillo L, Robson T, Langer F, Desai H, Davila M, Amaya M, Francis JL and Amirkhosravi A: Bevacizumab immune complexes activate platelets and induce thrombosis in FCGR2A transgenic mice. J Thromb Haemost. 7:171–181. 2009. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Drug-induced thrombocytopenia in a patient with colorectal cancer: A case report

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Abstract

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