98IN - Thrombosis in cancer patients

Date 01 October 2012
Event ESMO Congress 2012
Session Key topics in supportive care
Topics Supportive Care
Presenter Mario Dicato
Authors M.A. Dicato
  • Hematology- Oncology, Centre Hospitalier de Luxembourg, 1210 - Luxembourg/LU

Abstract

Arterial thrombosis is not a specific cancer related disorder except in some patients on some antiangiogenic drugs, but remains an infrequent event compared to venous thromboembolism (VTE). VTE is the second most frequent cause of death in cancer patients and is a predictor of mortality in hospitalized cancer patients. The death rate is about 30% in cancer patients when VTE occurs within 3 months of diagnosis. About 15% of patients suffering from cancer will have a VTE during the course of their disease and about 10% of patients with an idiopathic (?) VTE develop a cancer in the following two years. Risk factors for VTE in oncology are patient dependent, treatment dependent, type of cancer and stage dependent, The pathophysiology of VTE is complex. In addition to the standard causes, biomarkers and a clinical risk assessment score can be useful in deciding on time and duration of VTE prophylaxis and treatment. Prophylactic treatment in the ambulatory cancer patient needs to be discussed as newer anticoagulants like ultra low molecular weight heparin have been used recently in clinical trials and other novel agents (dabigatran, rivaroxaban and apixaban) marketed for orthopedic surgery and atrial fibrillation have become routine. The latter drugs are given orally, have negligeable interference with other medications or with foodstuffs and do not need laboratory surveillance. Approval for market release in VTE therapy in the general medical situation is pending and will certainly be used in the oncological setting if cost compatible. Various guidelines (ESMO, ASCO, NCCN …) are concurrent in their recommendations depending on disease activity, anti-cancer treatments (surgery, chemotherapy …) and the patient's clinical situation. These will be discussed in regards to the ambulatory and hospitalized patient, for first episode and for recurrent VTE. Some data are available though not presently recommended, for anticoagulant therapy in oncology for improving survival.

Disclosure

The author has declared no conflicts of interest.