Heparin and chemotherapy in the management of inoperable lung carcinoma

Eliasd, Elias G.; Shukla, Satish; Mink, Irving B.

doi:10.1002/1097-0142(197507)36:1<129::aid-cncr2820360109>3.0.co;2-s

Cited by 55 publications

(20 citation statements)

References 8 publications

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“…These studies frequently focus on heparin, as an anticoagulant. Studies have demonstrated regression in the primary tumor [17, 18], as well as a reduced likelihood of developing metastases [19]. …”

Section: Discussionmentioning

confidence: 99%

Can LMWH improve the outcome of patients with inoperable stage III non-small cell lung cancer?

Küçüköner¹,

Işıkdoğan²,

Kaplan³

et al. 2012

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Aim of the studyLung cancer is the most common malignancy, accounting for one-third of all deaths from cancer. Some studies have shown that low molecular weight heparin (LMWH) significantly prolongs the survival of patients with non-small cell lung cancer (NSCLC).The aim of this study was to determine the effects of treating inoperable stage III NSCLC with LMWH in addition to concurrent chemoradiotherapy.Material and methodsEighty-two patients with inoperable stage III NSCLC were evaluated at Dicle University's Medical Oncology Department between 2005 and 2010. All patients were treated with concurrent chemoradiotherapy (CRT) with or without LMWH (enoxaparin 4000 IU/day) depending on the patient's risk of thrombosis. The primary objectives were to determine disease-free survival (DFS) and overall survival (OS) for patients treated with LMWH.ResultsA total of 38 patients in the LMWH negative group and 44 patients in the LMWH positive group were included in the study. The median OS was 11.2 months for the enoxaparin recipients and 12.7 months for the non-enoxaparin group (p = 0.4). The median DFS was 9.3 months with CRT alone and 10.0 months with CRT plus enoxaparin (p = 0.9). The one-year OS rates were 47% and 34% for groups treated with CRT and enoxaparin plus CRT, respectively, while the two-year OS rates were 23% and 21%, respectively. No significant difference was noted between the two groups in terms of grade 3–4 hematologic toxicity and mucositis (p = 0.3).ConclusionsThis study did not demonstrate improvements in survival for patients with NSCLC treated with enoxaparin. LMWH's positive contribution is still controversial.

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Section: Discussionmentioning

confidence: 99%

Can LMWH improve the outcome of patients with inoperable stage III non-small cell lung cancer?

Küçüköner¹,

Işıkdoğan²,

Kaplan³

et al. 2012

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“…Elias et al (83) showed that tumors respond to the combined use of heparin with cytotoxic agents in a small group of cancer patients and that tumor regression could be observed in the patients with highly resistant cancers to that of chemotherapy alone. Edlis et al (84) reported an objective response in only one of 19 patients with lung cancer treated with heparin and cyclophosphamide.…”

Section: Application Of Anticoagulants Fibrinolytic or Antiplateletmentioning

confidence: 99%

Inhibition of the arrest of hematogenously disseminated tumor cells

1983

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Most metastases in patients occur as a result of hematogenous dissemination of tumor cells. This process of metastasis is complex and consists of several steps, foremost of which is the arrest of circulating emboli in capillary beds and the formation of a thrombus at that site. Thrombus formation in the metastasis of human cancer was described first by Billroth in 1878. It was reported that the organization of tumor cell emboli, and the subsequent penetration of tumor cells into the capillary wall, was the first stage of metastasis. Since then, many investigations and observations have been made clinically as well as experimentally to clarify the process (or mechanisms) of tumor cell arrest and how to inhibit it. Coagulative and fibrinolytic pathways were believed to have a main role in thrombus formation. However, other factors responsible for the relationship between tumor cells and the host must be also considered. Elegant and extensive studies by Fidler and Kripke demonstrated that development of metastasis is not a random process, but a selection process of specialized subpopulations of highly metastatic cells within the primary tumors. Biochemical constituents and ionic properties on cell surfaces, deformability or locomotive activities of tumor cells, as well as thrombo-plastic-fibrinolytic activities, are also important factors determining the arrest patterns of circulating tumor cells. On the other hand, host defense factors against tumor cells in the bloodstream have been attracting much attention recently in tumor immunology. Host defense factors relating the arrest of tumor cells to the establishment of metastatic foci seemed difficult to define, since many studies showed contradictory data concerning the influence of immune response on tumor cell arrest. Hemodynamic abnormality may also influence the arrest of tumor cells in the circulation. Hypercoagulability induced from host tissues is greatly associated with the arrest patterns. Platelet activities might affect thrombus formation. Nevertheless, exact explanations of the process or mechanisms inhibiting or enhancing the arrest of tumor cells after hematogenous dissemination have not been obtained. In any event, for cancer treatment, it is important to determine which substances inhibit the arrest of circulating tumor cells and how to prevent hematogenous metastasis. In this review, we will focus upon coagulative and fibrinolytic processes and then upon substances that inhibit the arrest of circulating tumor cells. Furthermore, some comments on the possible clinical applications of inhibitory substances for prevention of cancer metastasis are added.

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“…Due to their anticoagulant function, they can inhibit thrombin and fibrin formation induced by cancer cells, and therefore, heparins may potentially inhibit intravascular arrest of cancer cells and thus affects metastasis. However, some evidence shows that the anticoagulant properties of heparin is not the only way this molecule affects cancer progression, since heparin may modify gene expression, induce apoptosis [8][9][10] or differentiation [11] and inhibit drug resistance [12] in some cancer cells.…”

Section: Introductionmentioning

confidence: 99%