A prospective, randomized trial of chemotherapy with or without the low molecular weight heparin (LMWH) enoxaparin in patients (pts) with advanced pancreatic cancer (APC): Results of the CONKO 004 trial

Riess, Hanno; Pelzer, Uwe; Deutschinoff, G.; Opitz, Bernhard; Stauch, Martina; Reitzig, P; Hahnfeld, S.; Hilbig, A.; Stieler, Jens; Oettle, Helmut

doi:10.1200/jco.2009.27.15_suppl.lba4506

Cited by 24 publications

(9 citation statements)

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“…The two most recent trials, conducted in patients with advanced pancreatic cancer who receive systemic chemotherapy, have shown positive results with LMWH prophylaxis. In particular, the CONKO-004 trial found a 87% risk reduction of VTE (9.9% vs 1.3%; P < 0.01) using the LMWH enoxaparin at 1 mg/kg once daily for 3 months, compared with no prophylaxis; 43 , 44 while the FRAGEM study reported a 61% risk reduction of VTE (31% vs 12%; P = 0.02) using the CLOT 20 study therapeutic scheme of LMWH dalteparin. 45 …”

Section: Management Of Vte In Cancer Patients – Focus On the Use Of Lmentioning

confidence: 99%

Comparative assessment of low-molecular-weight heparins in cancer from the perspective of patient outcomes and survival

Falanga

Vignoli²,

Diani³

et al. 2011

PROM

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Patients with cancer are at high risk of developing venous thromboembolism (VTE), including deep venous thrombosis and pulmonary embolism. Compared to non-cancer patients, VTE in cancer is more frequently associated with clinical consequences, including recurrent VTE, bleeding, and an increase in the risk of death. Low-molecular-weight heparins (LMWHs) are commonly recommended for the prevention and treatment of VTE in cancer patients because of their favorable risk-to-benefit profile. Indeed, compared with vitamin K antagonists, LMWHs are characterized by a reduced need for coagulation monitoring, few major bleeding episodes, and once-daily dosing, which make these drugs more suitable in the cancer setting. Guidelines have been published recently with the aim to improve the clinical outcomes in cancer patients at risk of VTE and its complications. Coagulation activation in cancer may have a role not only in thrombosis but also in tumor growth and dissemination. Hence, inhibition of fibrin formation has been considered a possible tool against the progression of malignant disease. Clinical studies show that anticoagulant drugs may have a beneficial effect on survival in cancer patients, with a major role for LMWHs. Recently a number of prospective randomized clinical trials to test LMWHs to improve cancer survival as a primary endpoint in cancer patients have been conducted. Although the results are controversial, the interest in this research area remains high.

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Section: Management Of Vte In Cancer Patients – Focus On the Use Of Lmentioning

confidence: 99%

Comparative assessment of low-molecular-weight heparins in cancer from the perspective of patient outcomes and survival

Falanga

Vignoli²,

Diani³

et al. 2011

PROM

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“…The CONKO 004 trial addressed chemotherapy with or without LMWH, that is, enoxaparin (1 mg/kg) in patients ( n = 312) with advanced pancreatic cancer [ 75 ]. The primary endpoint was the reduction of symptomatic VTE within the first 12 weeks of treatment.…”

Section: Low-molecular-weight Heparin As Prophylaxis For Venous Thmentioning

confidence: 99%

“…In each group there was one tumor-related fatal hemorrhage. Preliminary data demonstrated no difference in time to progression, or survival for observation versus LMWH, respectively, (19 versus 22 weeks) and (29 versus 31 weeks) [ 75 ].…”

Section: Low-molecular-weight Heparin As Prophylaxis For Venous Thmentioning

confidence: 99%

Clinical Use of the Low-Molecular-Weight Heparins in Cancer Patients: Focus on the Improved Patient Outcomes

et al. 2011

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Patients with malignant neoplastic diseases represent a high-risk population relative to thromboembolic disease. With the advent of improved and accessible diagnostic technology, for example, ultrasound and/or spiral CT scans, timely diagnosis of venous thromboembolic events (VTE) is readily accomplished. The introduction of low-molecular-weight heparin (LMWH) approximately two decades ago (in contrast to unfractionated heparin and vitamin K antagonists) has provided a class of agents with a favorable therapeutic index. In the review to follow, the literature regarding the use of LMWH in oncologic patient populations is summarized. Topics addressed include prophylaxis, and treatment as well as consideration of the potential anti-neoplastic properties of this class of drugs.

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“…Several studies have assessed the use of LMWH or ultra-LMWH for thromboprophylaxis in outpatients undergoing chemotherapy (Table 2) [Agnelli et al 2011[Agnelli et al , 2009Haas et al 2005;Maraveyas et al 2011;Perry et al 2010;Reiss et al 2009]. Whereas some studies have showed a significant difference in overall or symptomatic VTE between the treatment groups, others have not.…”

Section: Outpatients Undergoing Chemotherapymentioning

confidence: 99%

Prevention and treatment of venous thromboembolism in patients with cancer

Hogg¹,

Carrier²

2011

Therapeutic Advances in Hematology

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Venous thromboembolism (VTE) is the second leading cause of death and a major cause of morbidity in patients with cancer. Pharmacologic thromboprophylaxis is recommended in all hospitalized cancer patients without contraindications to anticoagulants. The role of thromboprophylaxis in outpatients undergoing chemotherapy is less certain because of the diversity of the tumor types and their associated risks of VTE and bleeding. Thromboprophylaxis should only be considered in patients at high risk for VTE. Cancer patients with a newly diagnosed VTE should be preferably treated with low-molecular-weight heparin for a minimum of 3-6 months. Treatment duration should be individualized based on the clinical status and stage of the cancer, the risk of recurrent VTE, the risk of bleeding, and personal preference of the patient. Further research is required to assess the role of the new oral anticoagulants (direct Xa and thrombin inhibitors) for this high-risk population.

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A prospective, randomized trial of chemotherapy with or without the low molecular weight heparin (LMWH) enoxaparin in patients (pts) with advanced pancreatic cancer (APC): Results of the CONKO 004 trial

Cited by 24 publications

References 0 publications

Comparative assessment of low-molecular-weight heparins in cancer from the perspective of patient outcomes and survival

Comparative assessment of low-molecular-weight heparins in cancer from the perspective of patient outcomes and survival

Clinical Use of the Low-Molecular-Weight Heparins in Cancer Patients: Focus on the Improved Patient Outcomes

Prevention and treatment of venous thromboembolism in patients with cancer

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