Abstract 1692P
Background
Cancer-associated thrombosis (CAT) is a negative prognostic factor for survival during cancer treatment, accounting for 20% of total thrombosis. Attention should be devoted to CAT prophylaxis, since cancer patients are more vulnerable for bleeding and drug-drug interactions.
Methods
HeSMO conducted a prospective observational study (ACT4CAT), to record the clinical practice for thromboprophylaxis in ambulatory patients with high thrombotic active cancer. Patients were enrolled after signing informed consent.
Results
From 19 oncology departments, 628 patients were enrolled while 394 (62.7%) completed the study. 541 (86.1%, age: 65.4±12.4 years, BMI: 26.2±5.2 kg/m2) finished second visit (3-4 cycles of treatment) and their characteristics are depicted in the table. 78.1% had metastatic disease and 84.5% were treated with highly thrombogenic agents (HTAs), such as platinum (53.4%), antimetabolites (51.9%), and immunotherapy (11.8%). Notably, 53.8% of these agents had the potential to interact with direct oral anticoagulants (DOACs). Regarding clinical setting: 61.1% & 18.0% patients were at 1st and 2nd line, respectively & 9.2%, 3.1% in adjuvant & neoadjuvant setting. 59.5% had Khorana score ≥2. Anticoagulation agents administered: 90.7% tinzaparin, 5.2% fondaparinux, 2.0% bemiparin, 1.3% enoxaparin and rivaroxaban, apixaban by 0.4%, for 5.5±3.7 months duration. 68.6% of patients received intermediate dose regardless of clinical setting (1st, 2nd, adjuvant & neoadjuvant: 67.5%, 73.9%, 42.2% & 66.7% respectively, p=0.0028). 13 patients (2.4%) experienced thrombotic events. 11 minor bleeding events reported (2.0%). Table: 1692P
| Neoplasms | Incidence% | GenderF, % | Age≥65, % | BMI ≥30,% | Metastatic% | Khorana score≥2, % | HTAs% |
| Pancreatic | 27.0 | 41.4 | 52.1 | 13.0 | 76.7 | 100.0 | 90.4 |
| Lung | 26.6 | 22.6 | 59.0 | 21.5 | 88.4 | 58.3 | 88.0 |
| Colorectal | 10.7 | 34.7 | 58.6 | 6.9 | 83.0 | 19.0 | 96.6 |
| Gastric | 6.7 | 19.4 | 69.4 | 13.9 | 69.7 | 97.2 | 83.3 |
| Ovarian | 4.8 | 100.0 | 57.7 | 19.2 | 76.0 | 65.4 | 88.0 |
| Bladder | 4.4 | 17.4 | 79.2 | 16.7 | 72.7 | 37.5 | 91.3 |
| Breast | 4.3 | 95.7 | 21.7 | 13.0 | 71.4 | 13.0 | 65.2 |
| Prostate | 4.1 | 0.0 | 90.9 | 18.2 | 100.0 | 18.2 | 28.6 |
| Testicular | 2.2 | 0.0 | 0.0 | 8.3 | 0.0 | 25.0 | 58.3 |
| Uterine | 1.3 | 100.0 | 57.1 | 71.4 | 100.0 | 71.4 | 71.4 |
| Renal | 1.3 | 14.3 | 85.7 | 57.1 | 85.7 | 14.3 | 71.4 |
| Sarcomas | 1.1 | 50.0 | 66.7 | 50.0 | 66.7 | 0.0 | 33.3 |
| Head & neck | 0.9 | 50.0 | 60.0 | 0.0 | 33.3 | 0.0 | 100.0 |
| Cervical | 0.9 | 100.0 | 0.0 | 0.0 | 80.0 | 80.0 | 100.0 |
| Others | 3.7 | 22.2 | 35.0 | 30.0 | 52.9 | 0.0 | 85.0 |
Conclusions
CAT can negatively affect prognosis in patients with active cancer. Apart from Khorana score, high thrombotic risk tumors, metastasis, HTAs, along with bleeding risk and drug-drug interactions, also influence the clinical decision for thromboprophylaxis. Intermediate anticoagulation doses as thromboprophylaxis are safe and effective in active cancer.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Hellenic Society of Medical Oncology.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.