Cancer‐associated thrombosis and drug–drug interactions of antithrombotic and antineoplastic agents

Abstract

Venous thromboembolism (VTE) is often associated with malignant diseases and notably contributes to morbidity and mortality in patients with cancer. Cancer‐associated thrombosis (CAT) brings additional costs to health expenditures and has a negative impact on oncological outcomes. Either the recurrence rate of VTE or bleeding complications are also higher in patients with cancer. Prophylactic anticoagulation has been recommended in peri‐surgical periods, inpatient settings, and high‐risk ambulatory patients. Although various risk stratification scores are used, none are ideal for identifying patients who can benefit from anticoagulant prophylaxis. New risk scoring systems or biomarkers are needed to identify patients who are more likely to benefit from prophylaxis with low bleeding risk. The questions about the patients who will be given prophylaxis and those who develop thromboembolism, with which drug, and how long they will be treated are still not fully answered. Anticoagulation is the cornerstone of the treatment, but management of CAT remains complex. Low molecular weight heparins and direct oral anticoagulants are effective and safe options for the treatment of CAT. Recognizing adverse effects, drug–drug interactions, and accompanying conditions that cause dose adjustment is crucial. Prevention and treatment of VTE in patients with cancer require a multidisciplinary and patient‐based approach.Plain Language Summary Cancer‐associated thrombosis is a significant cause of mortality and morbidity in patients with cancer. Chemotherapy, surgery, and/or use of central venous access remarkably increase the risk of thrombosis. Prophylactic anticoagulation should be considered not only in inpatient follow‐up and during peri‐surgical period but also ambulatory patients with a high risk of thrombosis. Many parameters, such as drug–drug interactions, primary side of cancer, and comorbidities of patients should be considered when selecting anticoagulant drugs. More accurate risk stratification scores or biomarkers are still an unmet need.

A real-world pharmacovigilance study of amivantamab-related cardiovascular adverse events based on the FDA adverse event reporting system (FAERS) database

“…Venous thrombotic diseases, particularly pulmonary embolism, was the most common cardiovascular toxicity observed. Previous studies have demonstrated that patients with advanced lung cancer are at a heightened risk of developing venous thromboembolism (VTE), and the administration of specific anti-tumor therapy further escalates the incidence [8][9][10] . The role of EGFR inhibition in directly inducing endothelial damage or increasing thrombus formation has not been conclusively established.…”

Evaluation of oral chemotherapeutic drug therapy managed jointly by oncologists and pharmacists

“…Interactions between chemotherapy drugs and other drugs, Chinese herbs, or foods are frequent and severe. [31][32][33][34][35] Létinier et al analyzed the French pharmacovigilance database and found that, of 4,027 reports of adverse reactions caused by drug interactions, 82.02% resulted in serious ADRs. [36] However, the incidence of drug interactions associated with oral chemotherapy agents is currently unknown.…”

Cardio-Oncology: A New Discipline in Medicine and Its Relevance to Hematology

“…92 In terms of drug interactions, the rate of major bleeding events was highest when DOACs were used concurrently with BTKi (10%), vascular endothelial growth factor TKIs (7%), and epidermal growth factor receptor/anaplastic lymphoma kinase inhibitors (2%). 119,120 In general, strong modulators of CYP3A4 or P-glycoprotein (P-gp) are likely to cause significant drug-drug interactions with DOACs. 107…”