Acute and fatal thrombocytopenic thrombotic purpura after a single dose of pemetrexed

Alabiso, Irene; Baratelli, Chiara; Brizzi, Maria Pia; Bitossi, Raffaella; Ottone, Azzurra; Tampellini, Marco

doi:10.1007/s11096-014-0032-9

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…PMX has been approved in combination with cisplatin as a first-line treatment of MPM and non-small cell lung cancer (NSCLC) (Alabiso et al, 2014;Dhakal et al, 2011). In the phase I clinical trial, the intravenous administration of PMX was investigated to assess the maximum tolerated dose (MTD) and to establish a recommended dose for the phase II study (Curtin and Hughes, 2001).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Encapsulation in a rapid-release liposomal formulation enhances the anti-tumor efficacy of pemetrexed in a murine solid mesothelioma-xenograft model

Eldin

Lila

Kawazoe

et al. 2016

European Journal of Pharmaceutical Sciences

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Section: Accepted Manuscriptmentioning

confidence: 99%

Encapsulation in a rapid-release liposomal formulation enhances the anti-tumor efficacy of pemetrexed in a murine solid mesothelioma-xenograft model

Eldin

Lila

Kawazoe

et al. 2016

European Journal of Pharmaceutical Sciences

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“…In addition to Pembrolizumab, the patient was treated with carboplatin and pemetrexed which are approved for first line treatment of lung adenocarcinoma. Pemetrexed has been suspected as a possible cause of TTP in prior case reports 20 ; however, evidence in support of this is sparse and primarily speculative. It is also known that cancer itself can cause thrombotic microangiopathy (TMA) but this is usually seen at the onset or recurrence of the malignancy and this patient appeared to be in remission when his diagnosis of TTP was made.…”

Section: Discussionmentioning

confidence: 99%

Durable remission of thrombotic thrombocytopenic purpura in the setting of pembrolizumab therapy

et al. 2023

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Background: There is a small but growing number of thrombotic thrombocytopenic purpura (TTP) cases attributed to immune checkpoint inhibitor therapy, with nivolumab and ipilimumab therapy being the most frequently described in the literature.Study Design and Methods: This report evaluates the course of a patient with a history of metastatic adenocarcinoma of the lung who developed TTP following treatment with the PD-1 inhibitor Pembrolizumab. The patient was treated with six sessions of therapeutic plasma exchange and appeared to be in remission. Exacerbation occurred 4 days later, and seven more sessions of plasma exchange were performed along with four total doses of Rituximab, and a steroid taper with monitoring of platelet counts and ADAMTS13 activity.Results: His platelet count recovered to a peak of 318,000 UL with an ADAMTS13 activity of 77% at the time of discharge. The patient has been following up regularly for outpatient testing with no TTP relapse as of the completion of this report.Discussion: This is one of a few cases of Pembrolizumab-associated TTP reported in the literature with successful complete remission following treatment. Plasma exchange in this setting may be an especially beneficial therapeutic intervention because of the removal of both the anti-ADAMTS13 antibody as well as the immune system upregulating anti-PDL1 monoclonal antibody with replacement of ADAMTS13 from donor plasma. Longer duration of plasma exchange and monitoring for normalization of ADAMTS13 levels in addition to platelet count before cessation of treatment may improve durable remission rates in this entity.

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Prediction Model for Severe Thrombocytopenia Induced by Gemcitabine Plus Cisplatin Combination Therapy in Patients with Urothelial Cancer

Matsumoto,

Mizuno,

Ando

et al. 2024

Clin Drug Investig

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Acute and fatal thrombocytopenic thrombotic purpura after a single dose of pemetrexed

Abstract: Pemetrexed can cause TTP. Clinicians have to be alert for the rapid onset and aggressiveness of this possible side effect. It is difficult to recognise the first signs and symptoms.

Cited by 4 publications

References 9 publications

Encapsulation in a rapid-release liposomal formulation enhances the anti-tumor efficacy of pemetrexed in a murine solid mesothelioma-xenograft model

Encapsulation in a rapid-release liposomal formulation enhances the anti-tumor efficacy of pemetrexed in a murine solid mesothelioma-xenograft model

Durable remission of thrombotic thrombocytopenic purpura in the setting of pembrolizumab therapy

Prediction Model for Severe Thrombocytopenia Induced by Gemcitabine Plus Cisplatin Combination Therapy in Patients with Urothelial Cancer

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