Major grades 3 and 4 toxicities with cixutumumab and control were elevation of transaminases , 12 % and 6 % , respectively ; fatigue , 16 % and 12 % , respectively ; gastrointestinal , 35 % and 28 % , respectively ; neutropenia , 21 % and 10 % , respectively ; and thrombocytopenia , 16 % and 7 % , respecively .