Successful Management of Surgery and Chemotherapht for Breast Cancer Complicated by Idiopathic Thrombocytopenic Purpura Using Thrombopoietin Receptor Agonists—Report of Two Cases—

Abstract

Idiopathic thrombocytopenic purpura (ITP) is an acquired immune-mediated disorder leading to thrombocytopenia. Solid tumors complicated by ITP pose significant challenges due to perioperative and chemotherapy-related bleeding risks. Thrombopoietin receptor agonists (TPO-RAs) are second-line agents for steroid-refractory or intolerant ITP. ; however, reports on their use during cancer treatment are limited. Here, we report two cases of breast cancer with concurrent ITP successfully managed using TPO-RAs.

Case 1 : A 47-year-old woman diagnosed with breast cancer presented with thrombocytopenia, confirmed as ITP. Platelet counts were successfully maintained above 100,000/μL with eltrombopag (12.5-37.5 mg) and prednisolone (5 mg), enabling surgical intervention and adjuvant chemotherapy.

Case 2 : A 47-year-old woman with a history of ITP with stable platelet count since age 16 was diagnosed with breast cancer. Platelet transfusion facilitated surgery, while postoperative chemotherapy was completed with platelet counts maintained above 100,000/μL using eltrombopag (25-37.5 mg) and prednisolone (2.5 mg).

These cases highlight the efficacy of TPO-RAs combined with low-dose corticosteroids in achieving safe surgical and chemotherapeutic management of breast cancer complicated by ITP. TPO-RAs may offer a valuable treatment option for optimizing platelet counts in similar complex clinical scenarios.