An analysis of the efficacy and safety of direct oral anticoagulants (DOACs) in gastrointestinal cancer-associated venous thromboembolism (GI-CAVTE).

Abstract

505 Background: Two major trials and meta-analysis of patients (pts) with active cancer and VTE suggests that apixaban (A) and rivaroxaban (R) showed similar efficacy to enoxaparin and warfarin while having less associated major bleeding. GICA is associated with a higher incidence of VTE compared to other tumors. Moreover, bleeding complications of DOACs are not well defined in GICA pts. We compared the efficacy and safety of DOACs in pts with active GICA and VTE at the University of Arizona Cancer Center (UACC). Methods: A retrospective chart review of pts receiving DOACs with GICA and VTE treated at UACC was performed (11/2013-02/2017). GICA subgroup extracted from clinical trial delineations followed: active cancer, defined as cancer diagnosed at any stage +/- 6 months of VTE diagnosis. Efficacy outcomes were recurrent DVT, nonfatal pulmonary embolism (PE), or fatal PE. Safety outcomes for major bleeding were Hg drop of ≥2 g/dL, transfusion of ≥2 units of PRBC, bleeding in a critical site, or bleeding contributing to death. Fisher exact test is used for testing the difference in categorical variables for p-value < 0.05. Results: Our review included pts on A (n = 28) and R (n = 34). Pts had similar baseline characteristics compared to AMPLIFY (n = 81) and pooled-EINSTEIN (n = 71). Recurrent VTE at 6 months were 7.1% and 2.9% for pts on A and R, respectively. VTE historical comparison to AMPLIFY (3.7%) and EINSTEIN (2.8%) showed no significant difference. Major bleeding at 6 months were 7.1% and 14.7% for A and R, respectively, compared to 2.3% AMPLIFY / 2.8% EINSTEIN. R had the one recurrent non-fatal PE event and a significantly worse safety profile with 2 fatal bleeds (hemopericardium and upper GI bleed) and 2 critical bleeding sites (subarachnoid hemorrhage and retroperitoneal) [p = 0.0348], whereas A had non-significant of the before stated. Conclusions: To our knowledge, this is the first retrospective analysis to present long-term outcome data of DOACs in pts with GICA and VTE, which showed a similar risk of recurrent VTE and worse safety profile with R versus A. This data warrants further prospective clinical analysis of the efficacy and safety of DOACs in pts with GICA and VTE.

Profiles of differentially expressed circRNAs in esophageal and breast cancer

“…The high-risk areas include northern Iran, southern Russia, central Asian countries, and northern China, where esophageal squamous cell cancer (ESCC) accounts for 90% of all esophageal cancer cases. 3 The prognosis of ESCC is poor, and patients have only 15%–25% of 5-year survival rates after diagnosis. 4 – 6 …”

Rivaroxaban versus Low-Molecular-Weight Heparin for Venous Thromboembolism in Gastrointestinal and Pancreatobiliary Cancer

“…To our knowledge, there is only limited data for investigating bleeding risk in GI tract cancer patients administered rivaroxaban, and the present study is performed to compare bleeding risk in GI tract cancer patients treated with rivaroxaban versus standard treatment for VTE in cancer patients, i.e., LMWH 26. Patients receiving rivaroxaban showed a 1.904-fold increased hazard ratio in clinically relevant bleeding tendency compared to patients treated with LMWH.…”

Nucleolar spindle‐associated protein 1 promotes tumorigenesis and predicts poor prognosis in human esophageal squamous cell carcinoma

“…2 The main histological form of esophageal carcinoma, esophageal squamous cell carcinoma (ESCC), is one of the most aggressive malignancies. 3 Although diagnosis and surgical techniques have improved recently, patients with ESCC still have an unsatisfactory prognosis. Identifying the underlying molecular mechanisms linked with the tumorigenesis and progression of ESCC represents one of the most effective avenues of research.…”