FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence

Jiménez-Fonseca, Paula; Carmona-Bayonas, Alberto; Calderón, Caterina; Boj, Jordi Fontcuberta; Font, Carme; Monréal, Manuel; Martín, Andrés J. Muñoz; Otero, Remedios; Rubio, Amandine; Ruiz-Artacho, Pedro; Fernández, Carmen Suárez; Colomé, E.; Segura, Pedro Pérez

doi:10.1007/s12094-017-1632-3

Cited by 12 publications

(10 citation statements)

References 32 publications

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“…Added to that is the well-known greater complexity of managing VTE in patients with cancer [7] and the low level of evidence with which to confront any number of general or unique VTE-related situations (e.g., managing subjects with thrombopenia, with antiangiogenics, etc.) on a daily basis [8]. In addition, the intention of a prospective thrombosis registry is to contribute epidemiological and descriptive data that validate assumptions derived from clinical trials and facilitate the transference of inferences to daily work [18].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the multiple clinical practice guidelines regarding the prevention and management of CAT, numerous critical decisions about anticoagulant therapy, primary thromboprophylaxis, or management of special cases continue to be made with low levels of evidence [8]. The problem is exacerbated, in light of the high percentage of these patients who will not be eligible or will be under-represented in clinical trials, given the complexity of their clinical situation [9].…”

Section: Introductionmentioning

confidence: 99%

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A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Carmona-Bayonas

Gómez

Castro

et al. 2020

European Journal of Internal Medicine

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Background: The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. Method: TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. Results: Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. Conclusion: CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Carmona-Bayonas

Gómez

Castro

et al. 2020

European Journal of Internal Medicine

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“…Although patients with lymphoma are considered to have a high risk of VTE development, with the incidence rate reaching 7.2% in our study, routine thromboprophylaxis to prevent venous thromboembolism is not recommended by current international guidance [ 50 – 52 ]. It has recently been shown that currently available prediction scores including the Khorana, Vienna CATS, PROTECHT, and CONKO performed poorly in predicting venous thromboembolism in cancer patients and the use of prophylaxis in outpatients undergoing chemotherapy remains a controversial issue [ 42 , 53 ]. Therefore, our findings indicate the need for the identification of new biomarkers predictive of VTE, such as a pre-chemotherapy MPV≤25 th percentile, and for the improvement of lymphoma-specific VTE-assessment models.…”

Section: Discussionmentioning

confidence: 99%

Mean platelet volume as a predictive marker for venous thromboembolism in patients treated for Hodgkin lymphoma

et al. 2018

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Mean platelet volume (MPV) is reported to be associated with the risk of venous thromboembolism (VTE) and mortality in patients with cancer.We sought to determine the association of MPV with symptomatic VTE occurrence in patients treated for newly diagnosed Hodgkin lymphoma (HL) and their outcomes. We retrospectively studied 167 consecutive adult patients treated with HL. During first-line treatment 12 (7.2%) patients developed VTE and 14 (8%) died within the observation period. The pre-chemotherapy values of MPV were significantly lower in VTE patients than those without (p=0.0343). Patients with MPV≤25th percentile (6.8 fl) had an increased risk of VTE occurrence (p=0.0244). In multivariate analysis, MPV≤25th percentile (OR 2.21; 95%CI 1.07-4.57, p=0.033), advanced stage (OR 2.08; 95%CI 1.06-4.07, p=0.033) and bulky disease (OR 2.23; 95%CI 1.16-4.31, p=0.016) were significant factors for developing VTE. Only the impact of MPV≤25th percentile on VTE-free survival rates was found. VTE occurred in 43% (n=3) of the high-risk patients of the Thrombosis Lymphoma (ThroLy) score and in 17% (n=2) of the high-risk of the Khorana Risk Score (KRS). Neither the KRS nor the ThroLy score could identify patients at a high risk of VTE with a high degree of accuracy. We expanded the ThroLy score with the addition of the MPV≤25th percentile to more accurately identify HL patients with a higher risk of VTE.Our study indicates that the pre-chemotherapy MPV value, while of no use as an overall prognosis predictor, may still represent a useful prognostic marker for a significant VTE risk especially when incorporated into VTE-risk assessment models.

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“…The topics were identified by a recent Delphi study and completed by own experience. 6 The questions were distributed among four teams of three experts, including one member of each society (i.e., three questions per team). For every topic, the available literature (from previous guidelines to small studies) was reviewed and an initial consensus was reached inside each working team leading to a proposal of suggestions for the assigned questions.…”

Section: Methodsmentioning

confidence: 99%

Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

Pachón

Trujillo‐Santos

Domènech

et al. 2018

TH Open

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Despite the growing interest and improved knowledge about venous thromboembolism in cancer patients in the last years, there are still many unsolved issues. Due to the limitations of the available literature, evidence-based clinical practice guidelines are not able to give solid recommendations for challenging scenarios often present in the setting of cancer-associated thrombosis (CAT). A multidisciplinary expert panel from three scientific societies—Spanish Society of Internal Medicine (SEMI), Spanish Society of Medical Oncology (SEOM), and Spanish Society Thrombosis and Haemostasis (SETH)—agreed on 12 controversial questions regarding prevention and management of CAT, which were thoroughly reviewed to provide further guidance. The suggestions presented herein may facilitate clinical decisions in specific complex circumstances, until these can be made leaning on reliable scientific evidence.

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FOTROCAN Delphi consensus statement regarding the prevention and treatment of cancer-associated thrombosis in areas of uncertainty and low quality of evidence

Abstract: Though the level of consensus varied depending on the scenario presented, overall, the iterative process achieved broad agreement as to the general treatment principles of cancer-associated VTE. Clinical validation of these statements in genuine practice conditions would be useful.

Cited by 12 publications

References 32 publications

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Mean platelet volume as a predictive marker for venous thromboembolism in patients treated for Hodgkin lymphoma

Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

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