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Clinician Article

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Apixaban to Prevent Venous Thromboembolism in Patients with Cancer.

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• Carrier M
• Abou-Nassar K
• Mallick R
• Tagalakis V
• Shivakumar S
• Schattner A, et al.

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Clinical Comments

Hemostasis and Thrombosis

A perfectly good study but with predictable results.

Internal Medicine

Although the results are not particularly surprising, it is important to rely on evidence-based results rather than gestalt or anecdotal evidence. This study also puts to rest the suggestions from some that more bleeding vs stronger prophylaxis than was found would be expected.

Internal Medicine

I think this is new and interesting, but I'm not in heme-oncology. In the absence of an improvement in overall survival, I'm unsure it should change practice. Most VTE is not fatal, and one would end up giving anticoagulation to about 10% of the group rather than 100%.

Internal Medicine

This addresses a significant problem and provides a signal that this intervention may be valuable; however, it has significant limitation that limits generalization.

Oncology - Gastrointestinal

Oncologists are already using oral factor X inhibitors in selected patients with established thromboembolic events at the cost of higher risk of bleeding (both major and minor), so the results of this study are not surprising. Treatment was for only 6 months and we know that risk for thromboembolic events continues over time in this patient population. Should patients undergo prophylaxis on a continuous basis? This would certainly increase the risk for bleeding. 90% of the patients receiving placebo did not sustain an event. We need more information on risks and benefits with longer use before this practice is adopted. Physicians need to familiarize themselves with the Khorana scoring system, but a more predictive tool is required.

Oncology - Gastrointestinal

A well conducted trial that addresses an important facet of patient management. The results of this trial are known through oral presentations. It is good to have the full data published.

Oncology - Genitourinary

As a Uro Oncologist, I find this article is important in staking the claim of Eliquis (Apixaban) as prophylaxis. Patients with prostate cancer who have either undergone extensive pelvic lymphadenectomy or have bulky locally advanced disease, do present with DVT and it was a little odd that this cohort did not have too many patients with prostate cancer. Patients who undergo radical cystectomy for muscle-invasive bladder cancer are another large group of patients at risk for DVT and Apixaban would be useful in them; currently, we use LMWH in the post-op period as prophylaxis.

Oncology - Gynecology

The authors emphasize that clots are averted by treatment, but bleeding was also increased and there was no difference in mortality (and NS increase in mortality in the treatment arm). No cost-benefit analysis. Should not change treatment at this time.

Oncology - Gynecology

At last some evidence to support using a DOAC for cancer patients and showing safety as well as efficacy.

Oncology - Lung

Multiple cancers not just lung cancer and not in proportion to incidence. I presume these are all metastatic and not locally advanced. A small minority may be at risk. Are the potential risks and costs worth it? These issues are more directed to medical than radiation oncologists.