Direct oral anticoagulants for the treatment and prevention of venous thromboembolism in patients with cancer: current evidence

Venous thromboembolic disease (VTED) is a common and clinically important complication in patients with cancer, contributing to its mortality and morbidity. Direct oral anticoagulant agents (DOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, are as effective as vitamin K antagonists for the treatment of VTED and are associated with less frequent and severe bleeding. They have advantages over low-molecular-weight heparin, but comparative long-term efficacy and safety data are lacking for these compounds. Recent randomized clinical trials suggest a role for DOACs in the treatment of VTED in patients with cancer. This review will discuss the existing evidence and future perspectives on the role of DOACs in the treatment of VTE based on the current evidence about their overall efficacy and safety and the limited information in patients with cancer; in addition, we will briefly review their pharmacokinetic properties with special reference to potential interactions (AU)

SEOM clinical guidelines for anaemia treatment in cancer patients (2020).

Anaemia is defined by the presence of haemoglobin (Hb) levels < 13 g/dL in men and 12 g/dL in women. Up to 39% of cancer patients present it at the time of diagnosis and up to 40% have iron deficiency. Anaemia causes fatigue, functional deterioration and a reduction in the quality of life; it has also been associated with a poorer response to anti-tumour treatment and lower survival. Basic diagnostic tests for anaemia are simple and should be a routine part of clinical practice. These guidelines review the available evidence on the use of different therapies for treating anaemia: erythropoiesis-stimulating agents, iron supplements, and transfusion of blood products.

Direct oral anticoagulants for the treatment and prevention of venous thromboembolism in patients with cancer: current evidence.

Venous thromboembolic disease (VTED) is a common and clinically important complication in patients with cancer, contributing to its mortality and morbidity. Direct oral anticoagulant agents (DOACs), including direct thrombin inhibitors and direct factor Xa inhibitors, are as effective as vitamin K antagonists for the treatment of VTED and are associated with less frequent and severe bleeding. They have advantages over low-molecular-weight heparin, but comparative long-term efficacy and safety data are lacking for these compounds. Recent randomized clinical trials suggest a role for DOACs in the treatment of VTED in patients with cancer. This review will discuss the existing evidence and future perspectives on the role of DOACs in the treatment of VTE based on the current evidence about their overall efficacy and safety and the limited information in patients with cancer; in addition, we will briefly review their pharmacokinetic properties with special reference to potential interactions.

SEOM clinical guideline of venous thromboembolism (VTE) and cancer (2019).

In 2011, the Spanish Society of Medical Oncology (SEOM) first published a clinical guideline of venous thromboembolism (VTE) and cancer. This guideline was updated in 2014, and since then, multiple studies and clinical trials have changed the landscape of the treatment and prophylaxis of VTE in cancer patients. To incorporate the most recent evidence, including data from direct oral anticoagulants (DOACs) randomized clinical trials, SEOM presents a new update of the guideline.

Calidad de vida relacionada con la salud en pacientes oncológicos con enfermedad tromboembólica venosa aguda sintomática. Diseño del estudio qca (quality of life in cancer). Estudio de casos y controles / Health-related quality of life in cancer patients with acute symptomatic venous thromboembolic disease. Design of the QCa (quality of life in cancer) study. Case-control study

La asociación entre cáncer y enfermedad tromboembólica (ETV) se encuentra bien establecida. La ETV presenta una elevada morbimortalidad, objetivándose un incremento del riesgo de ETV hasta 4 veces mayor en aquellos pacientes con cáncer respecto a la población general. Sin embargo, existe poca evidencia científica sobre la CVRS (calidad de vida relacionada con la salud) en pacientes oncológicos con ETV, cuando es presumible que esta patología suponga un agravante sobre la percepción del estado de salud de los pacientes oncológicos. Nuestro objetivo es presentar el estudio "QCa Study", el cual pretende evaluar la CVRS de los pacientes oncológicos con ETV aguda sintomática en comparación con pacientes oncológicos sin ETV. "QCa study" es un estudio nacional de cohortes, prospectivo, de casos y controles en pacientes con cáncer activo. Definimos "caso" como aquel paciente oncológico con ETV aguda sintomática, y "control" aquel paciente oncológico sin ETV aguda sintomática. Los criterios de inclusión son: para los casos: presentar cáncer activo al momento de la inclusión. Tener más de 18 años, pacientes diagnosticados de trombosis venosa profunda (TVP) en miembros inferiores aguda sintomática o de embolia de pulmón (EP) confirmado de forma objetiva mediante pruebas de imagen y firma del consentimiento informado. Para los controles; presentar cáncer activo. Tener más de 18 años. Firma del consentimiento informado. Dado los escasos datos publicados respecto a la CVRS en pacientes con ETV, hemos diseñado el estudio Qca, para poder determinar el impacto que genera la ETV en la calidad de vida de los pacientes con cáncer

The association between cancer and venous thromboembolic disease (VTD) is well established. VTD presents a high rate of morbidity and mortality, with patients with cancer showing an increased risk of VTD that is up to 4 times greater than the general population. However, there is little scientific evidence on HRQoL (health-related quality of life) in cancer patients with VTD when this disease is likely to be an aggravating factor in perceived state of health among cancer patients. Our objective is to present the QCa study, which aims to evaluate the HRQoL of cancer patients with acute symptomatic VTD in comparison with cancer patients without VTD. The QCa study is a prospective, case-control national cohort study in patients with active cancer. We define "case" as a cancer patient with acute symptomatic VTD and "control" as a cancer patient without acute symptomatic VTD. Inclusion criteria for cases were: having active cancer at the time of inclusion, being over the age of 18, patients diagnosed with acute symptomatic deep vein thrombosis (DVT) in the lower extremities or pulmonary embolism (EP) that was objectively confirmed through imaging tests, and having signed the informed consent. For the controls: having active cancer, being over the age of 18, and having signed the informed consent. Given the scarce data published with regard to HRQoL in patients with VTD, we designed the QCa study to determine the impact VTD has on the quality of life of patients with cancer

Pleiotropic effects of heparins: does anticoagulant treatment increase survival in cancer patients?

The association between venous thromboembolism (VTE) and cancer has been recognized for more than 100 years. Numerous studies have been performed to investigate strategies to decrease VTE incidence and to establish whether treating VTE impacts cancer progression and overall survival. Accordingly, it is important to understand the role of the hemostatic system in tumorigenesis and progression, as there is abundant evidence associating it with cell survival and proliferation, tumor angiogenesis, invasion, and dissemination, and metastasis formation. In attempts to further the scientific evidence, several studies examine survival benefits in cancer patients treated with anticoagulant therapy, specifically treatment with vitamin K antagonists, unfractionated heparin, and low-molecular-weight heparin. Several studies and meta-analyses have been conducted with a special focus on brain tumors. However, no definitive conclusions have been obtained, and more well-designed clinical trials are needed

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Pleiotropic effects of heparins: does anticoagulant treatment increase survival in cancer patients?

The association between venous thromboembolism (VTE) and cancer has been recognized for more than 100 years. Numerous studies have been performed to investigate strategies to decrease VTE incidence and to establish whether treating VTE impacts cancer progression and overall survival. Accordingly, it is important to understand the role of the hemostatic system in tumorigenesis and progression, as there is abundant evidence associating it with cell survival and proliferation, tumor angiogenesis, invasion, and dissemination, and metastasis formation. In attempts to further the scientific evidence, several studies examine survival benefits in cancer patients treated with anticoagulant therapy, specifically treatment with vitamin K antagonists, unfractionated heparin, and low-molecular-weight heparin. Several studies and meta-analyses have been conducted with a special focus on brain tumors. However, no definitive conclusions have been obtained, and more well-designed clinical trials are needed.

Safety and efficacy of primary thromboprophylaxis in cancer patients

Cancer is often complicated by venous thromboembolism (VTE), a common and potentially fatal complication associated with poor prognosis in these patients. An increased incidence of VTE is being observed due to the advanced age of cancer patients, the thrombogenic effect of novel drugs and advances in the diagnosis of related complications. In this review, we look at five different risk groups of cancer patients with an increased probability of developing VTE, including hospitalized patients undergoing chemotherapy, patients undergoing a surgical procedure, ambulatory patients undergoing chemotherapy, patients with a central venous access and patients receiving antiangiogenic drugs or anticoagulant therapy due to previous chronic diseases. The aim of this review is to summarize the most important clinical evidence reported to date on the suitability of primary thromboprophylaxis to cancer patients. Recommendations have drawn up for each group based on current evidence and guidelines to facilitate decision-making in clinical practice (AU)

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Safety and efficacy of primary thromboprophylaxis in cancer patients.

Cancer is often complicated by venous thromboembolism (VTE), a common and potentially fatal complication associated with poor prognosis in these patients. An increased incidence of VTE is being observed due to the advanced age of cancer patients, the thrombogenic effect of novel drugs and advances in the diagnosis of related complications. In this review, we look at five different risk groups of cancer patients with an increased probability of developing VTE, including hospitalized patients undergoing chemotherapy, patients undergoing a surgical procedure, ambulatory patients undergoing chemotherapy, patients with a central venous access and patients receiving antiangiogenic drugs or anticoagulant therapy due to previous chronic diseases. The aim of this review is to summarize the most important clinical evidence reported to date on the suitability of primary thromboprophylaxis to cancer patients. Recommendations have drawn up for each group based on current evidence and guidelines to facilitate decision-making in clinical practice.

Effectiveness of oxaliplatin desensitization protocols

INTRODUCTION: Hypersensitivity reaction (HSR) to antineoplastic drugs can force doctors to stop treatment and seek other alternatives. These alternatives may be less effective, not as well tolerated and/or more expensive. Another option is to use desensitization protocols that induce a temporary state of tolerance by gradually administering small quantities of the antineoplastic drug until the therapeutic dosage is reached. The aim of this study is to assess the effectiveness of oxaliplatin desensitization protocols. MATERIALS AND METHODS: A retrospective observational study was carried out between January 2006 and May 2011. The inclusion criteria were patients undergoing chemotherapy treatment with oxaliplatin who had developed an HSR to the drug and who were candidates for continuing the treatment using a desensitization protocol. The patients' clinical records were reviewed and variables were gathered relating to the patient, the treatment, the HSR, and the desensitization protocol administered. The data were analysed using version 18.0 of the statistics program SPSS. RESULTS: A total of 53 desensitization protocols were administered to 21 patients. In 89 % of these cases, no new reactions occurred while the drug was being administered. New reactions of mild severity only occurred in 11 % of cases, and none of these reactions were severe enough for treatment to be stopped. All patients were able to complete the desensitization protocol. CONCLUSION: This study confirms that oxaliplatin desensitization protocols are safe and effective and allow patients to continue with the treatment that initially caused an HSR (AU)

Therapeutic management of chronic lymphocytic leukaemia: state of the art and future perspectives.

Chronic lymphocytic leukaemia (CLL) is a common, often incurable low-grade-B lymphoproliferative disorder. For many years, chlorambucil alone or with steroids has been the drug of choice in treatment-naive patients. Purine nucleoside analogues (PNAs) and, more recently, monoclonal antibodies (i.e. rituximab, alemtuzumab), have increased the potential for obtaining complete or even molecular remissions. Despite these advances, recurrent and/or relapsing disease remains a major concern. In this respect, new clinical and biological agents have recently been identified, which may allow a better selection for high-risk patients, who could be offered more aggressive therapies including haematopoietic stem cell transplantation (HSCT). Although autologous transplant does not appear to provide additional benefit in advanced refractory disease, allogeneic transplant may offer a chance for cure. Non-myeloablative allogeneic transplant probably has curative potential with a better toxicity profile, and it is actively being investigated. We will review the role of the current therapeutic approach to CLL, focusing on the most recent advances in chemoimmunotherapy and haematopoietic stem cell transplantation.

Adjuvant chemotherapy for stages II, III and IV of colon cancer

Colorectal cancer is the third most frequent malignant neoplasm in Western countries. After complete resection, 5-year overall survival varies according to the initial stage. Adjuvant chemotherapy (CT) is indicated in patients with colon cancer at high-risk stage II, stage III and after complete resection of metastases. 5-Fluorouracil (5FU), alone or modulated with levamisol or leucovorin (LV), oral fluoropyrimidines, raltitrexed, irinotecan and oxaliplatin have been studied as adjuvant therapy for colon cancer. Nowadays, oxaliplatin-based regimens, FOLFOX or FLOX, are considered as the standard adjuvant CT. If there are contraindications for oxaliplatin, the best alternatives are capecitabine or continuous infusion of 5FU/LV. The role of monoclonal antibodies, cetuximab and bevacizumab, combined with oxaliplatin/fluoropyrimidine-based CT is under investigation in clinical trials. This article reviews the state of the art and the future perspectives of adjuvant therapy in colon cancer. Prognostic and predictive factors are also commented on (AU)

Antibiotic prophylaxis with meropenem after allogeneic stem cell transplantation.

In the present study, we analyze the efficacy of prophylaxis with meropenem in patients receiving a matched related donor allogeneic transplant. In total, 38 patients were sequentially treated with meropenem starting on the day of the first febrile episode (n=17, group A) vs prophylactic meropenem starting on the first day with <500/mm(3) granulocytes (n=21, group B), and maintained until resolution of fever or after granulocyte count >500/mm(3). Of these, 16 (94%) patients in group A developed fever as compared to 16 (76%) in group B (P=0.02). While only one patient in group A did not require first-line antibiotherapy, there were seven (33%) in group B who did not require it (P=0.01) since fever lasted less than 72 h. In addition, 52% patients in group B did not require second-line antibiotics as compared to 11% among patients in group A (P=0.04). In multivariate analysis prophylaxis with meropenem (HR=2.83, 95% CI (1-8.02); P=0.04) and disease status at transplant (HR for early stage=0.15, 95% CI (0.04-0.62); P=0.04) significantly influenced the development of fever. In conclusion, the current pilot study suggests that the use of prophylaxis with meropenem during the period of neutropenia in patients undergoing allogeneic transplantation favorably affects the morbidity of the procedure by reducing febrile episodes.