Incidence and clinical implications of venous thromboembolism in advanced colorectal cancer patients: The ‘GISCAD-alternating schedule’ study findings

Mandalà, Mario; Barni, Sandro; Floriani, Irene; Isa, L.; Fornarini, Giuseppe; Marangolo, M.; Mosconi, S.; Corsi, Domenico; Rulli, Eliana; Frontini, L.; Cortesi, Enrico; Zaniboni, Alberto; Aglietta, Massimo; Labianca, Roberto

doi:10.1016/j.ejca.2008.09.005

Cited by 49 publications

(28 citation statements)

References 38 publications

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“…Finally, rates of VTE reported in clinical trials may underestimate the actual rate by as much as 10-fold. 62 It is exceedingly important that data regarding venous and arterial thromboembolism in clinical trials, particularly those evaluating new therapies, be collected and reported in a standardized fashion.…”

Section: Issues Regarding the Epidemiology Of Cancerassociated Thrombmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

Khorana

Streiff

Farge

et al. 2009

JCO

156

106

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PurposeVenous thromboembolism (VTE) is an increasingly frequent complication of cancer and its treatments, and is associated with worsened mortality and morbidity in patients with cancer.DesignThe Italian Association of Medical Oncology, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the French National Federation of the League of Centers Against Cancer, and the European Society of Medical Oncology have recently published guidelines regarding VTE in patients with cancer. This review, authored by a working group of members from these panels, focuses on the methodology and areas of consensus and disagreement in the various clinical guidelines as well as directions for future research.ResultsThere is broad consensus regarding the importance of thromboprophylaxis in hospitalized patients with cancer, including prolonged prophylaxis in high-risk surgical patients. Prophylaxis is not currently recommended for ambulatory patients with cancer (with exceptions) or for central venous catheters. All of the panels agree that low molecular weight heparins are preferred for the long-term treatment of VTE in cancer. Areas that warrant further research include the benefit of prophylaxis in the ambulatory setting, the risk/benefit ratio of prophylaxis for hospitalized patients with cancer, an understanding of incidental VTE, and the impact of anticoagulation on survival.ConclusionWe call for a sustained research effort to investigate the clinical issues identified here to reduce the burden of VTE and its consequences in patients with cancer.

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Section: Issues Regarding the Epidemiology Of Cancerassociated Thrombmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

Khorana

Streiff

Farge

et al. 2009

JCO

156

106

View full text Add to dashboard Cite

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“…However, due to the typical lack of symptoms with VTEs, they are often only diagnosed incidentally (2,3). In the present case, CT scans that were performed to evaluate the effectiveness of chemotherapy incidentally revealed LV thrombus.…”

Section: Discussionmentioning

confidence: 85%

“…A previous study reported that the majority of VTEs (92%) were identified during radiological examinations scheduled for tumor reevaluation (3).…”

Section: Introductionmentioning

confidence: 99%

Rapid occurrence of left ventricular thrombus associated with platinum-based chemotherapy plus cetuximab for the treatment of metastatic squamous cell carcinoma of the head and neck: A case report

Ikeda

Yamachika

Mizutani

et al. 2017

Molecular and Clinical Oncology

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Abstract. Platinum-based chemotherapy plus cetuximab represents the first-line treatment for recurrent or metastatic squamous cell carcinoma of the head and neck. The most common adverse events associated with cetuximab are infusion reactions and skin reactions, and a risk of venous thromboembolic events has also recently been reported in association with cetuximab. It is well known that thrombosis is a common complication of malignancy, and represents the second most frequent cause of mortality in cancer patients. The present study reports the case of a 79-year-old man who presented with lung and liver metastases from tongue squamous cell carcinoma, for which platinum-based chemotherapy plus cetuximab was administered. After 1 cycle, the patient showed rapid growth of a left ventricular (LV) thrombus, despite ongoing antiplatelet therapy for an old myocardial infarction. Anticoagulant therapy was administered to treat the LV thrombus, which resolved within 1 week. To the best of our knowledge, this represents the first reported case of rapidly occurring LV thrombus associated with platinum-based chemotherapy plus cetuximab. Platinum-based chemotherapy plus cetuximab may be associated with a higher risk of embolic thrombus. IntroductionPlatinum-based chemotherapy plus cetuximab represents the first-line treatment for recurrent or metastatic squamous cell carcinoma (SCC) of the head and neck (1). In the European Phase III EXTREME trial of patients with recurrent or metastatic SCC of the head and neck, the addition of cetuximab to platinum/5-fluorouracil (5-FU) in the first-line setting significantly improved the rates of overall survival, progression-free survival and overall response compared with platinum/5-FU alone (1). However, cetuximab treatment is associated with certain adverse events, the most common of which are infusion reactions and skin reactions. Additionally, a risk of venous thromboembolic events (VTEs) has recently been reported in association with cetuximab (1). It has been suggested that the association between cetuximab and risk of thrombosis may be due to the antiangiogenic effects of cetuximab (2).VTEs are considered to be under-diagnosed, as patients are typically asymptomatic at presentation and are often only diagnosed incidentally (2). A previous study reported that the majority of VTEs (92%) were identified during radiological examinations scheduled for tumor reevaluation (3).The present study reports the case of a 79-year-old man who presented with lung and liver metastases from a tongue SCC, and suffered rapid growth of a left ventricular (LV) thrombus following 1 cycle of platinum-based chemotherapy plus cetuximab. Anticoagulant therapy was administered to treat the LV thrombus, which resolved within 1 week. The current report highlights the potential association between platinum-based chemotherapy plus cetuximab and the increased risk of embolic thrombus. Case reportA 77-year old male patient initially presented to Department of Oral and Maxillofacial Reconstructive Surgery, Okayama

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“…However, this may simply be a reflection that 3 months of initial chemotherapy were not sufficient and patients should be treated for longer periods (at least 6 months) before contemplating a treatment break. Another GISCAD study randomised 266 patients to either intermittent FOLFIRI (alternating FOLFIRI for 2 months and stopping chemotherapy for 2 months) or continuous FOLFIRI till disease progression (Mandala et al, 2009). Once again, there were no significant differences in ORR, PFS or OS between the two strategies.…”

Section: What Is the Optimal Duration Of Treatment?mentioning

confidence: 99%

“…Once again, there were no significant differences in ORR, PFS or OS between the two strategies. Interestingly, patients treated with intermittent FOLFIRI had a reduced risk of venous thromboembolism -a complication with significant impact on patients' QoL (Mandala et al, 2009). A large phase III COIN trial addressing this issue has finished recruiting 2421 patients into a three arm comparison with one of the arms being intermittent treatment schedule vs control continuous treatment schedule.…”

Section: What Is the Optimal Duration Of Treatment?mentioning

confidence: 99%

Treatment in advanced colorectal cancer: what, when and how?

Chau

Cunningham

2009

Br J Cancer

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Treatment of advanced colorectal cancer (CRC) increasingly requires a multidisciplinary approach and multiple treatment options add to the complexity of clinical decision-making. Recently novel targeted therapy against angiogenesis and epidermal growth factor receptor completed a plethora of phase III studies. The addition of bevacizumab to chemotherapy improved the efficacy over chemotherapy alone in both first and second line settings, although the magnitude of benefit may not be as great when a more optimal chemotherapy platform is used. Studies performed thus far did not address conclusively whether bevacizumab should be continued in subsequent lines of treatment. Anti-angiogenesis tyrosine kinase inhibitors have not shown any additional benefit over chemotherapy alone so far. Although some benefits were seen with cetuximab in all settings of treating advanced CRC, K-ras mutation status provides an important determinant of who would not benefit from such a treatment. Caution should be exercised in combining anti-angiogenesis with anti-EGFR strategy until further randomised data become available. In this review, we have focused on the implications of these trial results on the everyday management decisions of treating advanced CRC.

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Incidence and clinical implications of venous thromboembolism in advanced colorectal cancer patients: The ‘GISCAD-alternating schedule’ study findings

Cited by 49 publications

References 38 publications

Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

Venous Thromboembolism Prophylaxis and Treatment in Cancer: A Consensus Statement of Major Guidelines Panels and Call to Action

Rapid occurrence of left ventricular thrombus associated with platinum-based chemotherapy plus cetuximab for the treatment of metastatic squamous cell carcinoma of the head and neck: A case report

Treatment in advanced colorectal cancer: what, when and how?

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