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Developed prostate cancer and had external beam radiation. Which medicine should I take?

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Posted on Wed, 10 Oct 2012
Question: I have had cronic ITP for the last year. Last year went thu a four week round of Rituxan which worked and kept me above 50 k for six months. I developed Prostate cancer and had external beam radiation. The oncologist radiation
Dr. wanted my platelets to be higher ,so my Hematologist started me on Nplate and worked great for 3 weeks at a time. When I finished radiation she started me on a once a week four round of Rituxan and with some of the Nplate in my system my count stayed above 50 k easy. after the third round of rituxan i had a reaction whe re I blacked out after the treatment while driving out of the hospital. My count droped the next week to 34k and thjis week it was 29k. She still feels that the rituxan might still take hold and raise my count. If not after this week
she is going back to Nplate for two months then if it continues to stay low seriously concider a spleen removal.
My question is there any other med out there that might work to rise my count without doing real bodly harm.
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Answered by Dr. Pavan Kumar Gupta (27 hours later)
Hello
Thanks for the query.
The common treatments for chronic ITP include corticosteroids,Anti-D and intravenous immunoglobulin ( IVIG ).
However,when these treatment fail then platelet boosters like Nplate come into picture and have their role.Platelet boosters are medicines which imitate thrombopoietin ( TPO ). TPO is the protein that tells special cells in the bone marrow to produce platelets and so thereby increasing platelet production.Unlike most treatments for ITP,platelet boosters do not work by interfering with the immune system.
The only other platelet booster available is ELTROMBOPAG( PROMACTA ) which is an oral preparation while ROMIPLOSTIM ( Nplate ) is an injectable drug.
Both these medicines have been approved by FDA to treat patients of chronic ITP who have had an insufficient response to other drugs.
However ELTROMBOPAG appears to have less value than N plate due to more potential drug-drug interactions,risk of rare and serious side effects and uncertain longterm benefit.
Your doctor is quite right in advising you a splenectomy if Nplate doesn't give you response.
Unfortunately there is no other drug which can offer you real benefits and low side effects.

I hope to have answered your query however you may revert to me for any further query.
Best of luck
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Pavan Kumar Gupta

General & Family Physician

Practicing since :1978

Answered : 6704 Questions

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Developed prostate cancer and had external beam radiation. Which medicine should I take?

Hello
Thanks for the query.
The common treatments for chronic ITP include corticosteroids,Anti-D and intravenous immunoglobulin ( IVIG ).
However,when these treatment fail then platelet boosters like Nplate come into picture and have their role.Platelet boosters are medicines which imitate thrombopoietin ( TPO ). TPO is the protein that tells special cells in the bone marrow to produce platelets and so thereby increasing platelet production.Unlike most treatments for ITP,platelet boosters do not work by interfering with the immune system.
The only other platelet booster available is ELTROMBOPAG( PROMACTA ) which is an oral preparation while ROMIPLOSTIM ( Nplate ) is an injectable drug.
Both these medicines have been approved by FDA to treat patients of chronic ITP who have had an insufficient response to other drugs.
However ELTROMBOPAG appears to have less value than N plate due to more potential drug-drug interactions,risk of rare and serious side effects and uncertain longterm benefit.
Your doctor is quite right in advising you a splenectomy if Nplate doesn't give you response.
Unfortunately there is no other drug which can offer you real benefits and low side effects.

I hope to have answered your query however you may revert to me for any further query.
Best of luck
Thanks