Biomarker directed thromboprophylaxis reduces risk of thromboembolism in Cancer patients: JAMA

Thromboprophylaxis, the prevention of blood clots, is a critical concern for individuals undergoing systemic anticancer therapies. Recent research published in the Journal of American Medical Association showed that tailored strategies based on biomarkers hold great potential in enhancing the effectiveness of thromboprophylaxis. 

Conducted between June 2018 and July 2021, this phase 3 randomized clinical trial involved adults aged 18 or older commencing systemic anticancer therapies for lung or gastrointestinal cancers in Australia. The trial, carried out in one metropolitan and four regional hospitals, implemented a risk assessment based on fibrinogen and d-dimer levels. Patients were categorized into low-risk (observation) and high-risk (randomized) cohorts. High-risk patients were further randomized into two groups: one receiving enoxaparin (a blood-thinning medication) and the other receiving no thromboprophylaxis (the control group).

Among the 328 enrolled participants, 61% had gastrointestinal cancer, 39% had lung cancer, and 40% had metastatic disease. Notably, in the high-risk cohort, those who received enoxaparin showed a significantly lower rate of thromboembolism (blood clots) compared to the control group (8% vs. 23%). Additionally, the low-risk individuals who received no intervention had a lower risk of thromboembolism than the high-risk control group (8% vs. 23%). The risk model used demonstrated a sensitivity of 70% and a specificity of 61%.

Crucially, the study found that risk-directed thromboprophylaxis with enoxaparin reduced thromboembolism without significant safety concerns. It also significantly reduced mortality at the six-month mark. The findings strongly suggest that biomarker-driven, risk-directed primary thromboprophylaxis is a promising and suitable approach for individuals with lung and gastrointestinal cancers undergoing systemic anticancer therapies. This approach not only enhances the effectiveness of thromboprophylaxis but also ensures that low-risk patients avoid unnecessary interventions, improving overall patient care.

These results mark a significant step forward in the field of cancer treatment, potentially saving lives and improving the quality of life for many individuals undergoing systemic anticancer therapies for lung and gastrointestinal cancers. Further research and clinical implementation of this risk-directed approach hold great promise for the future of cancer care.

Reference:

Alexander, M., Harris, S., Underhill, C., Torres, J., Sharma, S., Lee, N., Wong, H., Eek, R., Michael, M., Tie, J., Rogers, J., Heriot, A. G., Ball, D., MacManus, M., Wolfe, R., Solomon, B. J., & Burbury, K. (2023). Risk-Directed Ambulatory Thromboprophylaxis in Lung and Gastrointestinal Cancers. In JAMA Oncology. American Medical Association (AMA). https://doi.org/10.1001/jamaoncol.2023.3634