Abstract 1585P
Background
The thrombotic risk, up to 9 times higher in cancer patients than in general population, has increased over recent years, might due to increased survival of cancer patients, novel cancer therapies, & increased diagnostic modalities. Most of the thrombotic events observed shortly before & after cancer diagnosis. Thomboprophylaxis in oncology patients remains a challenge.
Methods
HeSMO conducted 2 prospective observational studies (GMaT & ACT4CT) aiming to record thromboprophylaxis daily clinical practice in ambulatory patients with active cancer. Patients enrolled after signing informed consent.
Results
1117 patients from 26 oncology centers recruited (age: 65.2±12.2 years, BMI: 26.1±5.2 Kg/m2, 59.7% males). 74.3% had metastasis, 82.6% treated with Highly Thrombogenic Agents (HTAs), such as platinum (53.3%), antimetabolites (50.0%), immunotherapy (10.0%) and 21% with radiotherapy. 52.8% of HTAs had potential drug-drug interactions (DDIs) with Direct Oral Anticoagulants. 61.5% & 15.7% of patients were at 1st & 2nd line respectively & 9.7%, 6.2% in adjuvant & neoadjuvant setting. 58.5% had Khorana score ≥2. Details depicted in table. Anticoagulation agents include (in%): 91.9 tinzaparin, 4.5 fondaparinux, 2.1 bemiparin, 1.1 enoxaparin, 0.2 rivaroxaban & apixaban, for 5.2±3.2 months duration. 61.3% of patients received intermediate dose (1st, 2nd, adjuvant & neoadjuvant: 61.4%, 67.3%, 43.0% & 71.4% respectively). 30 patients (2.7%) had thrombotic events, related to: thrombosis history (OR: 4.6, p=0.0030), radiotherapy (OR: 2.6, p=0.0092), prophylactic dose (OR: 2.8, p=0.0049). 18 minor bleeding events reported (1.6%). Table: 1585P
| Cancer | Treatment | Patient | Biomarker | |||||
| Primary Site | Incidence (%) | Females (%) | Metastatic (%) | HTAs (%) | Radiotherapy (%) | Age ≥65 | Comorbidities (%) | Khorana score ≥2 |
| Lung | 25.5 | 21.7 | 82.7 | 83.1 | 34.3 | 56.7 | 46.1 | 63 |
| Pancreatic | 22.1 | 42.2 | 75.8 | 97.1 | 3.3 | 55.3 | 35.8 | 100 |
| Colorectal | 9.6 | 41.1 | 80.8 | 88.8 | 16 | 58.9 | 52.3 | 19.6 |
| Stomach | 7.6 | 28.6 | 73.4 | 91.6 | 10.7 | 60.7 | 47.6 | 100 |
| Breast | 5.9 | 98.4 | 68.8 | 56.1 | 45.2 | 37.9 | 60.6 | 10.6 |
| Ovarian | 5.5 | 100 | 66.1 | 85 | 1.7 | 59 | 50.8 | 59 |
| Bladder | 4.8 | 22.5 | 70 | 84.9 | 18.9 | 71.7 | 54.7 | 45.3 |
| Prostate | 3.7 | - | 95.1 | 40 | 34.2 | 85.4 | 65.9 | 17.1 |
| Testicular | 2 | - | 14.3 | 100 | - | 4.6 | 13.6 | 36.4 |
| Head & neck | 1.4 | 30 | 63.6 | 80 | 73.3 | 33.3 | 53.3 | - |
| Uterine | 0.7 | 100 | 83.3 | 87.5 | 12.5 | 62.5 | 25 | 62.5 |
| Cervical | 0.5 | 100 | 80 | 100 | 20 | - | 20 | 80 |
| Others | 10.9 | 45.6 | 60.5 | 61.7 | 28.6 | 60.3 | 52.1 | 26.5 |
Conclusions
High thrombotic burden neoplasms, metastatic disease, HTAs, potential DDIs, influence doctors’ decision for anticoagulation apart from Khorana score. Thromboprophylaxis in high risk patients with active cancer endures during anti-neoplasmatic treatment and seem both effective and safe.
Clinical trial identification
NCT03292107, NCT03909399.
Editorial acknowledgement
Mr. Avraam Poulakis and Hellenic Society of Medical Oncology (HeSMO).
Legal entity responsible for the study
Hellenic Society of Medical Oncology (HeSMO).
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.