By Nancy Lapid
(Reuters) -Amgen’s Nplate, which treats low blood platelet counts caused by an autoimmune condition, was highly effective at preventing a similar common and serious complication of powerful chemotherapy cancer drugs, researchers reported ahead of the American Society of Clinical Oncology meeting in Chicago.
The 165 patients in the pivotal trial had either colorectal, gastroesophageal, or pancreatic cancer. They were all receiving toxic cancer drugs that caused them to have chemotherapy-induced thrombocytopenia – an abnormally low blood platelet count – after only a single session.
A low platelet level “puts patients with cancer at a high risk of severe or potentially fatal internal bleeding,” said study leader Dr. Hanny Al-Samkari of the Massachusetts General Hospital in Boston.
It also “impacts the ability to treat patients with the indicated chemotherapy given as it should be, at full dose and on time,” he added.
Trial participants received either a weekly subcutaneous injection of Nplate, known chemically as romiplostim, or a placebo. Nplate acts by stimulating the bone marrow to increase platelet production.
Of those in the Nplate group, 84% did not need any reductions of their subsequent chemotherapy doses due to a low platelet count, the researchers found. That was true for only 36% of patients in the placebo group.
After taking individual risk factors into account, patients receiving Nplate were more than 10 times more likely than patients in the placebo group to continue their cancer treatments without a dose reduction.
“Reduced chemotherapy intensity has been clearly shown to worsen survival of patients… reducing the likelihood of cure in curable patients and shortening the lives of incurable patients,” Al-Samkari said.
There are no FDA-approved drugs to treat chemotherapy-induced platelet loss, he noted.
“These results are therefore potentially practice‑changing for a common serious condition encountered routinely in clinical practice worldwide that prevents delivery of on-time, full-dose anti-cancer therapy,” Al-Samkari said.
AI IMPROVES PATIENT SELECTION FOR HER2 CANCER DRUGS
Artificial intelligence can improve a doctor’s accuracy at identifying breast cancer patients who could benefit from treatment with drugs that target the HER2 protein on cancer cells, researchers found in a study that will be presented at the ASCO meeting.
These drugs, including AstraZeneca’s Enhertu, are beneficial even when patients’ levels of the protein are extremely low. However, low or ultra-low levels can be hard to detect, leaving some patients misclassified as HER2-negative.
About 50% to 60% of breast cancer patients likely fall into the low-HER2 category, according to the U.S. National Cancer Institute.
Willingness to use Enhertu to treat breast cancer has far outpaced the ability to determine with certainty which patients might benefit, experts have said.
Funded by AstraZeneca, researchers worked with MindPeak to develop a training program to help pathologists assess HER2 levels in breast cancer. They recruited 105 pathologists from 10 countries to take the course and to analyze tumor samples from 20 patients, both with and without AI assistance.
The pathologists’ accuracy at determining HER2 clinical categories – null, ultra-low, low, or positive – improved from 66.7% without AI to 88.5% with AI.
Misclassification of HER2-ultralow cases as HER2-negative occurred in 29.5% of readings without AI but decreased to 4.0% with AI assistance.
“Our study provides the first multinational evidence that artificial intelligence can help enhance accuracy” in determining HER2 clinical categories, “potentially closing critical diagnostic gaps and enabling more patients to have access to new therapies, said Dr. Marina De Brot of the A.C. Camargo Cancer Center in Sao Paulo, Brazil, who led the study.
“Until recently, most of these patients would have not been offered these options,” she said.
EXTRA PRE-TREATMENT MAY IMPROVE ESOPHAGEAL CANCER SURGERY OUTCOMES
A cancer immunotherapy drug from China’s BeiGene used in inoperable esophageal cancer may also change the way some operable esophagus tumors are treated, a mid-stage trial suggests.
When patients with newly diagnosed esophageal cancer that has begun to grow beyond its original location have completed their standard pre-operative chemotherapy, a second course of treatment that includes BeiGene’s Tevimbra given before surgery can significantly improve their outcomes, researchers reported in advance of ASCO 2025.
Researchers recruited 87 such patients whose tumors were no longer seen on imaging exams after chemotherapy with paclitaxel and carboplatin, plus radiation.
Ordinarily, the next step in their care would be surgery to remove part or all of the esophagus, at which point pathologists would examine the excised tissue to see if any cancer cells remained. Cancer cells lingering after surgery contribute to the more than 50% recurrence rate in these patients, the researchers said.
Half the patients in the study received two additional treatments with chemotherapy and Tevimbra, while the rest went directly to surgery.
When pathologists examined the tissues removed during surgery, 40.7% of Tevimbra-treated patients were free of any lingering cancer cells, compared with 18.1% of the control group.
After accounting for individual risk factors, patients in the Tevimbra group were nearly three times more likely to have what is known as a pathological complete response.
One year later, 95.6% of patients in the Tevimbra group were alive without their disease worsening, known as progression-free survival, compared with 77.3% of patients who did not receive the extra treatment before surgery. That difference was not deemed to be statistically significant, however.
“This pioneering study demonstrates that sequential chemo-immunotherapy… significantly improves pathological complete response rates by more than two-fold and shows promising progression-free survival trends with manageable toxicity,” the researchers said.
They called for larger late-stage trials to confirm the results that could “redefine the standard-of-care.”
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(Reporting by Nancy Lapid; editing by Bill Berkrot)
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