Goal 2: Reduce Human Disease

Thrombprophylaxis in cancer patients

What is needed to identify the cancer patients that would benefit from thromboprophylaxis and the agents that should be used?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

The close relationship between cancer and thrombosis has been known since the days of Armand Trousseau, who first described the clinical association between idiopathic venous thromboembolism (VTE) and occult malignancy in 1865. Today, we know that some cancers are associated with a hypercoagulable state and up to four-fold increase in thrombosis risk, with chemotherapy elevating this risk even more. Thrombosis has a significant impact on the morbidity and mortality of cancer; therefore, it is important to identify which patients may be at higher risk than others, especially before starting chemo-radiotherapy or surgery. However, there is no standard of care for thromboprophylaxis in cancer patients. Identification specific groups of risk for thrombosis and appropriate anticoagulation regimen, especially in mid-level risk groups, would provide direct benefit to the outcome in cancer patients.

Feasibility and challenges of addressing this CQ or CC

Epidemiologic and population-based studies provide detailed information on the scale of the problem and the identification of VTE risk factors, including those related to the tumor (tumor type, clinical stage, chemotherapy, use of anti-angiogenic drugs or erythropoietic growth factors, and insertion of central venous catheters), and those related to individual patient characteristics (sex, race, age, previous VTE history, immobilization, and obesity). Additional factors and biomarkers of thrombosis have been established in recent years. A new generation of oral anticoagulants that potentially can make thromboprophylaxis in cancer patients safer and easier, has been developed. All these achievements may transform the current empirical nature of anticoagulants use in cancer to scientifically justified, efficient and safe thromboprophylaxis.

 

 

While there is a clear progress in our understanding of the mechanisms associated with the development of malignancy, we know little of the mechanisms of cancer-related thrombosis. There is evident lack of collaboration between basic scientists and clinical oncologists, which would be required for natural history and biomarker studies. Efficient collaboration is required between National Cancer Institute and National Heart, Lung, and Blood Institute to coordinate efforts and leverage resources in addressing this important research and clinical challenge.

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Idea No. 342