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Cancers
Special Issues
Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer
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Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (31 January 2020) | Viewed by 47882

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Patrizia Ferroni

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Guest Editor
1. Interinstitutional Multidisciplinary Biobank (BioBIM), IRCCS San Raffaele Roma, 00166 Rome, Italy
2. Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166 Rome, Italy
Interests: biomarker discovery; decision support systems; predictive medicine; artificial intelligence
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Mario Roselli

E-Mail Website
Guest Editor
Department of Systems Medicine, Medical Oncology, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
Interests: cancer chemotherapy; venous thromboembolism; decision support systems; predictive medicine
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Fiorella Guadagni

E-Mail Website
Guest Editor
1. BioBIM (InterInstitutional Multidisciplinary Biobank), IRCCS San Raffaele Roma, 00166 Rome, Italy
2. Department of Human Sciences & Quality of Life Promotion, San Raffaele Roma Open University, 00166 Rome, Italy
Interests: biomarker discovery; cancer biomarkers; decision support systems; predictive medicine; artificial intelligence
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thromboembolism is a compelling challenge in cancer care because of its life-threatening nature as well as impact on specific treatments. Current guidelines do not generally recommend antithrombotic prophylaxis, except in selected categories of patients at high risk of thrombosis. Accordingly, several clinical decision models have been developed to guide the oncologist in thromboembolic risk assessment and targeted prophylaxis.
Low molecular weight heparin (LMWH) are currently considered as the standard approach in clinical practice guidelines, but recent randomized controlled trials (RCT) have indicated that direct oral anticoagulants (DOACs) are effective for the treatment/prophylaxis of cancer-associated thromboembolism. However, many unanswered questions remain on the efficacy and safety of anticoagulants in selective cancer subgroups, and in primary and secondary prevention settings, where anticoagulation needs to be balanced on the risk of bleeding complications. Tailored approaches based on the use of individualized factors to stratify the thrombotic/bleeding risk in each individual patient will represent a significant advance in the prevention of cancer-associated thromboembolism.
This Special Issue will cover the current clinical evidence supporting the standard of care and emerging treatment/prophylactic options for cancer-associated thromboembolism. Evidence on anticoagulant effects on the quality-of-life perception in cancer patients will be also welcomed.

Prof. Patrizia Ferroni
Prof. Mario Roselli
Prof. Fiorella Guadagni
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cancer-associated thromboembolism
  • low molecular weight heparin
  • direct oral anticoagulants
  • bleeding risk
  • risk assessment
  • thromboprophylaxsis
  • treatment

Published Papers (13 papers)

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Editorial

Jump to: Review, Other

5 pages, 214 KiB  
Editorial
Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer
by Patrizia Ferroni, Fiorella Guadagni and Mario Roselli
Cancers 2021, 13(7), 1556; https://doi.org/10.3390/cancers13071556 - 29 Mar 2021
Cited by 1 | Viewed by 1743
Abstract
Venous thromboembolism (VTE) is a compelling challenge across all phases of cancer care as it may result in treatment delays, impaired quality of life (QoL), and increased mortality [...] Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)

Review

Jump to: Editorial, Other

15 pages, 253 KiB  
Review
Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer
by Alice Labianca, Tommaso Bosetti, Alice Indini, Giorgia Negrini and Roberto Francesco Labianca
Cancers 2020, 12(8), 2070; https://doi.org/10.3390/cancers12082070 - 27 Jul 2020
Cited by 8 | Viewed by 2367
Abstract
In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous [...] Read more.
In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous thromboembolism (VTE) there is the so-called Virchow triad, but tumor cells can activate coagulation pathway by various direct and indirect mechanisms, and chemotherapy can contribute to VTE onset. For these reasons, several studies were conducted in order to assess efficacy and safety of the use of anticoagulant therapy in cancer patients, both in prophylaxis setting and in therapy setting. With this review, we aim to record principal findings and current guidelines about thromboprophylaxis in cancer patients, with particular attention to subjects with additional risk factors such as patients receiving chemotherapy or undergoing surgery, hospitalized patients for acute medical intercurrent event and patients with central venous catheters. Nonetheless we added a brief insight about acute and maintenance therapy of manifested venous thromboembolism in cancer patients. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
13 pages, 234 KiB  
Review
Impact of Tumor Genomic Mutations on Thrombotic Risk in Cancer Patients
by Orly Leiva, Jean M. Connors and Hanny Al-Samkari
Cancers 2020, 12(7), 1958; https://doi.org/10.3390/cancers12071958 - 19 Jul 2020
Cited by 21 | Viewed by 2587
Abstract
Venous thromboembolism (VTE) is common in patients with cancer and is an important contributor to morbidity and mortality in these patients. Early thromboprophylaxis initiated only in those cancer patients at highest risk for VTE would be optimal. Risk stratification scores incorporating tumor location, [...] Read more.
Venous thromboembolism (VTE) is common in patients with cancer and is an important contributor to morbidity and mortality in these patients. Early thromboprophylaxis initiated only in those cancer patients at highest risk for VTE would be optimal. Risk stratification scores incorporating tumor location, laboratory values and patient characteristics have attempted to identify those patients most likely to benefit from thromboprophylaxis but even well-validated scores are not able to reliably distinguish the highest-risk patients. Recognizing that tumor genetics affect the biology and behavior of malignancies, recent studies have explored the impact of specific molecular aberrations on the rate of VTE in cancer patients. The presence of certain molecular aberrations in a variety of different cancers, including lung, colon, brain and hematologic tumors, have been associated with an increased risk of VTE and arterial thrombotic events. This review examines the findings of these studies and discusses the implications of these findings on decisions relating to thromboprophylaxis use in the clinical setting. Ultimately, the integration of tumor molecular genomic information into clinical VTE risk stratification scores in cancer patients may prove to be a major advancement in the prevention of cancer-associated thrombosis. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
17 pages, 553 KiB  
Review
Venous Thromboembolism in Lymphoma: Risk Stratification and Antithrombotic Prophylaxis
by Stefan Hohaus, Francesca Bartolomei, Annarosa Cuccaro, Elena Maiolo, Eleonora Alma, Francesco D’Alò, Silvia Bellesi, Elena Rossi and Valerio De Stefano
Cancers 2020, 12(5), 1291; https://doi.org/10.3390/cancers12051291 - 20 May 2020
Cited by 18 | Viewed by 2873
Abstract
Lymphoma is listed among the neoplasias with a high risk of venous thromboembolism (VTE). Risk factors for VTE appear to differ from risk factors in solid tumors. We review the literature of the last 20 years for reports identifying these risk factors in [...] Read more.
Lymphoma is listed among the neoplasias with a high risk of venous thromboembolism (VTE). Risk factors for VTE appear to differ from risk factors in solid tumors. We review the literature of the last 20 years for reports identifying these risk factors in cohorts consisting exclusively of lymphoma patients. We selected 25 publications. The most frequent studies were analyses of retrospective single-center cohorts. We also included two reports of pooled analyses of clinical trials, two meta-analyses, two analyses of patient registries, and three analyses of population-based databases. The VTE risk is the highest upfront during the first two months after lymphoma diagnosis and decreases over time. This upfront risk may be related to tumor burden and the start of chemotherapy as contributing factors. Factors consistently reported as VTE risk factors are aggressive histology, a performance status ECOG ≥ 2 leading to increased immobility, more extensive disease, and localization to particular sites, such as central nervous system (CNS) and mediastinal mass. Association between laboratory values that are part of risk assessment models in solid tumors and VTE risk in lymphomas are very inconsistent. Recently, VTE risk scores for lymphoma were developed that need further validation, before they can be used for risk stratification and primary prophylaxis. Knowledge of VTE risk factors in lymphomas may help in the evaluation of the individual risk-benefit ratio of prophylaxis and help to design prospective studies on primary prophylaxis in lymphoma. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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18 pages, 364 KiB  
Review
Venous Thromboembolism in Cancer Patients on Simultaneous and Palliative Care
by Silvia Riondino, Patrizia Ferroni, Girolamo Del Monte, Vincenzo Formica, Fiorella Guadagni and Mario Roselli
Cancers 2020, 12(5), 1167; https://doi.org/10.3390/cancers12051167 - 06 May 2020
Cited by 5 | Viewed by 3261
Abstract
Simultaneous care represents the ideal integration between early supportive and palliative care in cancer patients under active antineoplastic treatment. Cancer patients require a composite clinical, social and psychological management that can be effective only if care continuity from hospital to home is guaranteed [...] Read more.
Simultaneous care represents the ideal integration between early supportive and palliative care in cancer patients under active antineoplastic treatment. Cancer patients require a composite clinical, social and psychological management that can be effective only if care continuity from hospital to home is guaranteed and if such a care takes place early in the course of the disease, combining standard oncology care and palliative care. In these settings, venous thromboembolism (VTE) represents a difficult medical challenge, for the requirement of acute treatments and for the strong impact on anticancer therapies that might be delayed or, even, totally discontinued. Moreover, cancer patients not only display high rates of VTE occurrence/recurrence but are also more prone to bleeding and this forces clinicians to optimize treatment strategies, balancing between hemorrhages and thrombus formation. VTE prevention is, therefore, regarded as a double-edged sword. Indeed, while on one hand the appropriate use of antithrombotic agents can reduce VTE occurrence, on the other it significantly increases the bleeding risk, especially in the frail patients who present with multiple co-morbidities and poly-therapy that can interact with anticoagulant drugs. For these reasons, thromboprophylaxis should start while active cancer treatment is ongoing, according to a simultaneous care model in a patient-centered perspective. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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15 pages, 966 KiB  
Review
Direct Oral Anticoagulants in Cancer Patients. Time for a Change in Paradigm
by Marek Z. Wojtukiewicz, Piotr Skalij, Piotr Tokajuk, Barbara Politynska, Anna M. Wojtukiewicz, Stephanie C. Tucker and Kenneth V. Honn
Cancers 2020, 12(5), 1144; https://doi.org/10.3390/cancers12051144 - 02 May 2020
Cited by 19 | Viewed by 3461
Abstract
Thrombosis is a more common occurrence in cancer patients compared to the general population and is one of the main causes of death in these patients. Low molecular weight heparin (LMWH) has been the recognized standard treatment for more than a decade, both [...] Read more.
Thrombosis is a more common occurrence in cancer patients compared to the general population and is one of the main causes of death in these patients. Low molecular weight heparin (LMWH) has been the recognized standard treatment for more than a decade, both in cancer-related thrombosis and in its prevention. Direct oral anticoagulants (DOACs) are a new option for anticoagulation therapy. Recently published results of large randomized clinical trials have confirmed that DOAC may be a reasonable alternative to LMWH in cancer patients. The following review summarizes the current evidence on the safety and efficacy of DOAC in the treatment and prevention of cancer-related thrombosis. It also draws attention to the limitations of this group of drugs, knowledge of which will facilitate the selection of optimal therapy. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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23 pages, 315 KiB  
Review
Primary Thromboprophylaxis in Pancreatic Cancer Patients: Why Clinical Practice Guidelines Should Be Implemented
by Dominique Farge, Barbara Bournet, Thierry Conroy, Eric Vicaut, Janusz Rak, George Zogoulous, Jefferey Barkun, Mehdi Ouaissi, Louis Buscail and Corinne Frere
Cancers 2020, 12(3), 618; https://doi.org/10.3390/cancers12030618 - 06 Mar 2020
Cited by 16 | Viewed by 3284
Abstract
Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 [...] Read more.
Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
14 pages, 255 KiB  
Review
Preventing Venous Thromboembolism in Ambulatory Patients with Cancer: A Narrative Review
by Anne Rossel, Helia Robert-Ebadi and Christophe Marti
Cancers 2020, 12(3), 612; https://doi.org/10.3390/cancers12030612 - 06 Mar 2020
Cited by 6 | Viewed by 2405
Abstract
Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer [...] Read more.
Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer stage, or the type of chemotherapeutic regimen. Landmark studies evaluating thrombophrophylaxis with low molecular weight heparin (LMWH) for ambulatory cancer patients have shown a relative reduction in the rate of symptomatic VTE of about one half. However, the absolute risk reduction is modest among unselected patients given a rather low risk of events resulting in a number needed to treat (NNT) of 40 to 50. Moreover, this modest benefit is mitigated by a trend towards an increased risk of bleeding, and the economic and patient burden due to daily injections of LMWH. For these reasons, routine thromboprophylaxis is not recommended by expert societies. Advances in VTE risk stratification among cancer patients, and growing evidence regarding efficacy and safety of direct oral anticoagulants (DOACs) for the treatment and prevention of CAT have led to reconsider the paradigms of this risk–benefit assessment. This narrative review aims to summarize the recent evidence provided by randomized trials comparing DOACs to placebo in ambulatory cancer patients and its impact on expert recommendations and clinical practice. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
10 pages, 256 KiB  
Review
Thromboprophylaxis in the End-of-Life Cancer Care: The Update
by Ewa Zabrocka and Ewa Sierko
Cancers 2020, 12(3), 600; https://doi.org/10.3390/cancers12030600 - 05 Mar 2020
Cited by 7 | Viewed by 3136
Abstract
Cancer patients are at increased risk for venous thromboembolism (VTE), which further increases with advanced stages of malignancy, prolonged immobilization, or prior history of thrombosis. To reduce VTE-related mortality, many official guidelines encourage the use of thromboprophylaxis (TPX) in cancer patients in certain [...] Read more.
Cancer patients are at increased risk for venous thromboembolism (VTE), which further increases with advanced stages of malignancy, prolonged immobilization, or prior history of thrombosis. To reduce VTE-related mortality, many official guidelines encourage the use of thromboprophylaxis (TPX) in cancer patients in certain situations, e.g., during chemotherapy or in the perioperative period. TPX in the end-of-life care, however, remains controversial. Most recommendations on VTE prophylaxis in cancer patients are based on the outcomes of clinical trials that excluded patients under palliative or hospice care. This translates to the paucity of official guidelines on TPX dedicated to this group of patients. The problem should not be underestimated as VTE is known to be associated with symptoms adversely impacting the quality of life (QoL), i.e., limb or chest pain, dyspnea, hemoptysis. In end-of-life care, where the assurance of the best possible QoL should be the highest priority, VTE prophylaxis may eliminate the symptom burden related to thrombosis. However, large randomized studies determining the benefits and risks profiles of TPX in patients nearing the end of life are lacking. This review summarized available data on TPX in this population, analyzed potential tools for VTE risk prediction in the view of this group of patients, and summarized the most current recommendations on TPX pertaining to terminal care. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
11 pages, 855 KiB  
Review
Potential Mechanisms of Cancer-Related Hypercoagulability
by Nicola J. Nasser, Jana Fox and Abed Agbarya
Cancers 2020, 12(3), 566; https://doi.org/10.3390/cancers12030566 - 29 Feb 2020
Cited by 44 | Viewed by 9715
Abstract
The association between cancer and thrombosis has been known for over a century and a half. However, the mechanisms that underlie this correlation are not fully characterized. Hypercoagulability in cancer patients can be classified into two main categories: Type I and Type II. [...] Read more.
The association between cancer and thrombosis has been known for over a century and a half. However, the mechanisms that underlie this correlation are not fully characterized. Hypercoagulability in cancer patients can be classified into two main categories: Type I and Type II. Type I occurs when the balance of endogenous heparin production and degradation is disturbed, with increased degradation of endogenous heparin by tumor-secreted heparanase. Type II hypercoagulability includes all the other etiologies, with factors related to the patient, the tumor, and/or the treatment. Patients with poor performance status are at higher risk of venous thromboembolism (VTE). Tumors can result in VTE through direct pressure on blood vessels, resulting in stasis. Several medications for cancer are correlated with a high risk of thrombosis. These include hormonal therapy (e.g., tamoxifen), chemotherapy (e.g., cisplatin, thalidomide and asparaginase), molecular targeted therapy (e.g., lenvatinib, osimertinib), and anti-angiogenesis monoclonal antibodies (e.g., bevacizumab and ramucirumab). Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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17 pages, 1606 KiB  
Review
Primary Thromboprophylaxis in Ambulatory Cancer Patients: Where Do We Stand?
by Frits I. Mulder, Floris T. M. Bosch and Nick van Es
Cancers 2020, 12(2), 367; https://doi.org/10.3390/cancers12020367 - 05 Feb 2020
Cited by 17 | Viewed by 3950
Abstract
Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is a frequent complication in ambulatory cancer patients. Despite the high risk, routine thromboprophylaxis is not recommended because of the high number needed to treat and the risk of bleeding. Two recent trials demonstrated [...] Read more.
Venous thromboembolism (VTE), comprising deep-vein thrombosis and pulmonary embolism, is a frequent complication in ambulatory cancer patients. Despite the high risk, routine thromboprophylaxis is not recommended because of the high number needed to treat and the risk of bleeding. Two recent trials demonstrated that the number needed to treat can be reduced by selecting cancer patients at high risk for VTE with prediction scores, leading the latest guidelines to suggest such an approach in clinical practice. Yet, the interpretation of these trial results and the translation of the guideline recommendations to clinical practice may be less straightforward. In this clinically-oriented review, some of the controversies are addressed by focusing on the burden of VTE in cancer patients, discussing the performance of available risk assessment scores, and summarizing the findings of recent trials. This overview can help oncologists, hematologists, and vascular medicine specialists decide about thromboprophylaxis in ambulatory cancer patients. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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17 pages, 731 KiB  
Review
Multiple Myeloma and Thrombosis: Prophylaxis and Risk Prediction Tools
by Despina Fotiou, Maria Gavriatopoulou and Evangelos Terpos
Cancers 2020, 12(1), 191; https://doi.org/10.3390/cancers12010191 - 13 Jan 2020
Cited by 48 | Viewed by 6014
Abstract
Thromboembolism in multiple myeloma (MM) patients remains a common complication that renders the optimization of our thromboprophylaxis practice necessary. This review aims to make clear the need for the development of more accurate risk assessment tools and means of thrombosis prevention. Current clinical [...] Read more.
Thromboembolism in multiple myeloma (MM) patients remains a common complication that renders the optimization of our thromboprophylaxis practice necessary. This review aims to make clear the need for the development of more accurate risk assessment tools and means of thrombosis prevention. Current clinical practice is guided by available guidelines published by the IMWG in 2014, but the extent to which these are implemented is unclear. Recently, several groups developed clinical scores for thrombosis risk in MM in an attempt to improve risk stratification, but these have not been validated or used in clinical practice so far. Research in this field is increasingly focusing on understanding the unique coagulation profile of the MM patient, and data on potential biomarkers that accurately reflect hypercoagulability is emerging. Finally, promising evidence on the effectiveness of direct oral anticoagulants (DOACs) in the context of thrombosis prevention in MM patients is increasingly becoming available. The critical appraisal of the above research areas will establish the necessity of combining disease-specific clinical risk factors with coagulation biomarkers to allow more effective risk stratification that will eventually lead to the reduction of this significant complication. Results from ongoing clinical trials on the role of DOACs are much anticipated. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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Other

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8 pages, 505 KiB  
Brief Report
Observational Multicenter Study on the Prognostic Relevance of Coagulation Activation in Risk Assessment and Stratification in Locally Advanced Breast Cancer. Outline of the ARIAS Trial
by Laura Pizzuti, Eriseld Krasniqi, Chiara Mandoj, Daniele Marinelli, Domenico Sergi, Elisabetta Capomolla, Giancarlo Paoletti, Claudio Botti, Ramy Kayal, Francesca Romana Ferranti, Isabella Sperduti, Letizia Perracchio, Giuseppe Sanguineti, Paolo Marchetti, Gennaro Ciliberto, Giacomo Barchiesi, Marco Mazzotta, Maddalena Barba, Laura Conti and Patrizia Vici
Cancers 2020, 12(4), 849; https://doi.org/10.3390/cancers12040849 - 01 Apr 2020
Cited by 2 | Viewed by 2160
Abstract
A hypercoagulable state may either underlie or frankly accompany cancer disease at its onset or emerge in course of cancer development. Whichever the case, hypercoagulation may severely limit administration of cancer therapies, impose integrative supporting treatments and finally have an impact on prognosis. [...] Read more.
A hypercoagulable state may either underlie or frankly accompany cancer disease at its onset or emerge in course of cancer development. Whichever the case, hypercoagulation may severely limit administration of cancer therapies, impose integrative supporting treatments and finally have an impact on prognosis. Within a flourishing research pipeline, a recent study of stage I-IIA breast cancer patients has allowed the development of a prognostic model including biomarkers of coagulation activation, which efficiently stratified prognosis of patients in the study cohort. We are now validating our risk assessment tool in an independent cohort of 108 patients with locally advanced breast cancer with indication to neo-adjuvant therapy followed by breast surgery. Within this study population, we will use our tool for risk assessment and stratification in reference to 1. pathologic complete response rate at definitive surgery, intended as our primary endpoint, and 2. rate of thromboembolic events, intended as our secondary endpoint. Patients’ screening and enrollment procedures are currently in place. The trial will be shortly enriched by experimental tasks centered on next-generation sequencing techniques for identifying additional molecular targets of treatments which may integrate current standards of therapy in high-risk patients. Full article
(This article belongs to the Special Issue Risk Prediction and New Prophylaxis Strategies for Thromboembolism in Cancer)
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