Biomarkers for prediction of venous thromboembolism in cancer

Abstract

Cancer patients are at increased risk of deep vein thrombosis and pulmonary embolism. The incidence among different groups of cancer patients varies considerably depending on clinical factors, the most important being tumor entity and stage. Biomarkers have been specifically investigated for their capacity of predicting venous thromboembolism (VTE) during the course of disease. Parameters of blood count analysis (elevated leukocyte and platelet count and decreased hemoglobin) have turned out to be useful in risk prediction. Associations between elevated levels and future VTE have been found for d-dimer, prothrombin fragment 1+2, and soluble P-selectin and also for clotting factor VIII and the thrombin generation potential. The results for tissue factor–bearing microparticles are heterogeneous: an association with occurrence of VTE in pancreatic cancer might be present, whereas in other cancer entities, such as glioblastoma, colorectal, or gastric carcinoma, this could not be confirmed. Risk assessment models were developed that include clinical and laboratory markers. In the high-risk categories, patient groups with up to a >20% VTE rate within 6 months can be identified. A further improvement in risk stratification would allow better identification of patients for primary VTE prevention using indirect or novel direct anticoagulants.

A kórházi és az ambuláns kemoterápiában részesülő onkológiai betegek vénásthromboembolia-profilaxisának aktuális kérdései

“…Pabinger és mtsai a Vienna Cancer and Thrombosis Studyban (CATS) több biomarkert mértek, hogy meghatározzák, melyek használhatók a VTE előrejelzésére [23][24][25]. Megállapították, hogy a D-dimer és a P-szelektin együttes vizsgálata és ezek emelkedése volt a legérzékenyebb biomarker.…”

“…A tumorok sejtmentes DNS-t, prokoagulánst és növe-kedési faktorokat szabadítanak fel, amelyek fokozzák a vénás thrombosist [25]. Idesoroljuk a szöveti faktor (TF) -pozitív microvesiculákat, az IL-1B-t, az IL-6-ot, az IL-8-at, a trombopoetint (TPO) és a granulocytakolónia-stimuláló faktort (G-CSF).…”

Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review

“…Despite the fact that prophylactic and therapeutic anticoagulation seems to be effective and safe for cirrhotic patients [86][87][88] , an individual risk/benefit evaluation which takes prognosis, anticancer treatment options and acute anticoagulation-associated bleeding risk, as well as future complications with the associated consequences for surgical interventions and the risk of variceal hemorrhage into consideration is challenging. , Pabinger et al [75] and Verso et al [76] Khorana score criteria [75] D-dimer > 1.44 µg/mL 1 Soluble P-selectin > 153.1 µg/mL 1 High risk > 4 Protecht prediction score (additional parameters to Khorana score) [76] Cisplatin or carboplatin 1 Gemcitabine 1 High risk > 3 1 High grade glioma are considered very high risk site of cancer in the Vienna prediction score only. ESA: Erythropoiesis stimulating agents.…”

“…For example, the introduction of bevacizumab for the treatment of advanced colorectal cancer not only resulted in a clinically relevant increase in bleeding, but in thromboembolic complications as well [75,77,78] . Moreover, drug-associated VTE may become an important factor limiting further cancer therapy development.…”

“…Until results from this study become available, the initiation of pharmacological prophylaxis in high risk patients is suggested by the standardization subcommittee of the ISTH [74] . Supplementing the Khorana score with lab parameters such as D-dimer and soluble P-selectine [75] or chemotherapy components such as gemcitabine and cis-or car-boplatin [76] may further categorize patients according to their VTE risk.…”