The risk of venous thromboembolism is increased throughout the course of malignant glioma

Marras, L.C.; Geerts, William; Perry, James

doi:10.1002/1097-0142(20000801)89:3<640::aid-cncr20>3.0.co;2-e

Cited by 272 publications

(157 citation statements)

References 37 publications

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“…The high incidence of deep vein thrombosis and pulmonary embolism in patients with HGG confounds separation as an independent toxicity of antiangiogenic therapies, although antiangiogenic therapy may aggravate this thrombogenic predisposition. [51][52][53][54] A retrospective review of bevacizumab plus therapy in patients with recurrent HGG suggests that concurrent use of anticoagulation appears safe without an apparent increased risk of hemorrhage. 33 In conclusion, bevacizumab as a single agent used at this dose and schedule in patients with previously treated alkylator chemotherapy-refractory recurrent 1p19q codeleted AO appears of benefit (as determined by response rate and PFS-6) for recurrent alkylator-refractory AO/ AOA.…”

Section: Original Articlementioning

confidence: 99%

Bevacizumab for recurrent alkylator‐refractory anaplastic oligodendroglioma

Chamberlain

Johnston

2009

Cancer

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BACKGROUND:A retrospective evaluation of single agent bevacizumab was carried out in adults with recurrent alkylator‐refractory 1p19q codeleted anaplastic oligodendrogliomas (AO) with an objective of determining progression‐free survival (PFS). There is no standard therapy for alkylator‐resistant AO, and hence a need exists for new therapies.METHODS:Twenty‐two patients aged 24 to 60 years with recurrent AO were treated. All patients had previously been treated with surgery, radiotherapy, adjuvant chemotherapy (temozolomide, 17; carmustine wafers, 4; carmustine, 1), and 1 salvage regimen (procarbazine, lomustine, and vincristine, 15; temozolomide, 6; carmustine wafers, 1). Eleven patients underwent repeat surgery. Patients were treated at second recurrence with bevacizumab, once every 2 weeks, defined as a single cycle. Neurological evaluation was performed every 2 weeks, and neuroradiographic assessment was made after the initial 2 cycles of bevacizumab and subsequently after every 4 cycles of bevacizumab.RESULTS:A total of 391 cycles of bevacizumab (median, 14.5 cycles; range, 2‐39 cycles) were administered. Bevacizumab‐related toxicity included fatigue (14 patients; 4 grade 3), leukopenia (9; 1 grade 3), anemia (5; 0 grade 3), hypertension (5; 1 grade 3), deep vein thrombosis (4; 1 grade 3), and wound dehiscence (2; 1 grade 3). Fifteen (68%) patients demonstrated a partial radiographic response, 1 (5.0%) demonstrated stable disease, and 6 (27%) demonstrated progressive disease after 2 cycles of bevacizumab. Time to tumor progression ranged from 1 to 18 months (median, 6.75 months). Survival ranged from 3 to 19 months (median, 8.5 months). Six‐month and 12‐month PFS were 68% and 23%, respectively.CONCLUSIONS:Bevacizumab demonstrated efficacy and acceptable toxicity in this cohort of adults with recurrent 1p19q codeleted alkylator‐refractory AO. Cancer 2009. © 2009 American Cancer Society.

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Section: Original Articlementioning

confidence: 99%

Bevacizumab for recurrent alkylator‐refractory anaplastic oligodendroglioma

Chamberlain

Johnston

2009

Cancer

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“…It is thought that thromboembolic events that occur postoperatively following resection may be due to the tumor-induced hemostatic changes resulting in a hypercoagulable state and may be exacerbated by the post-surgical recovery period when patients are initially non-ambulatory. Because of this, patients with brain tumors, including meningiomas are at increased risk of developing deep vein thrombosis (DVT) and experiencing venous thromboembolic events (VTE) [6][7][8][9]. DVT and VTEs significantly increase tumor patient morbidity and mortality and therefore are important aspects of tumor treatment to address.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

et al. 2009

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Patients with brain tumors including intracranial meningiomas are at increased risk for developing deep vein thrombosis (DVTs) and suffering thromboembolic events (VTEs). Many surgeons are concerned that early use of low dose enoxaparin may increase the risk of intracranial hemorrhage which outweighs the benefit of DVT/VTE reduction. We aimed to address concerns around the use of enoxaparin after meningioma resection in the development of postoperative intracranial hemorrhages and DVT/VTEs. This is a retrospective review of 86 patients with intracranial meningiomas who underwent craniectomy and surgical resection of the mass, treated by one attending surgeon at UCSF Medical Center between 2000 and 2005. Within 48 h after surgery patients treated 2003-2005 routinely received enoxaparin therapy unless there was documented intracranial hemorrhage, lumbar subarachnoid drain, enoxaparin hypersensitivity, or thrombocytopenia (n = 24). These were compared to a cohort treated 2000-2002 who did not receive the drug (n = 62). Exclusion criteria were prior VTEs or coagulopathies. The groups were similar in tumor and surgical characteristics. Enoxaparin therapy did not increase the incidence of intracranial hemorrhage following surgical meningioma resection and the incidence of DVTs/VTEs was 0% (n = 0) versus 4.8% (n = 3) in the non-enoxaparin group. Results did not reach statistical significance. In this retrospective study, postoperative administration of enoxaparin following meningioma resection does not increase the risk of intracranial hematoma though enoxaparin administration may slightly decrease the incidence of post-surgical thromboembolic events. Due to study design and power, we were not able to demonstrate DVT/VTE reduction with statistical significance.

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“…Additionally, there was recognized at the onset of clinical trial design that patients with GBM were highly predisposed to thromboembolic phenomena [10][11][12][13][14][15][16][17][18][19][20]. Thus, it was further hypothesized that the administration of dalteparin, a LMWH, might provide prophylaxis for TEE.…”

Section: Introductionmentioning

confidence: 99%

Effect of dalteparin and radiation on survival and thromboembolic events in glioblastoma multiforme: a phase II ECOG trial

Robins

O’Neill

Gilbert

et al. 2007

Cancer Chemother Pharmacol

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Laboratory and clinical studies support the concept that heparins, particularly the low molecular component, may serve as an inhibitor of angiogenesis, providing anti-neoplastic effects. Further, treatment with low molecular weight heparin (LMWH) may provide prophylaxis for thromboembolic events (TEE), in glioblastoma (GBM) patients. Dalteparin (5000 u sub Q daily) was given with and after conventional radiotherapy to newly diagnosed GBM patients. Forty-five patients were accrued between 5/02 and 9/04; 3 were ineligible. At time of progression, patients could continue dalteparin in addition to standard regimens. Pretreatment characteristics included: Median age 61 (range 26-78); ECOG Performance status: 0=38%, 1=57%, 2=5%; gross total resection 45%. There were no grade 3/4 bleeding or thrombocytopenic events, and no TEE occurred while on dalteparin. Median time on dalteparin was 6.3 months, median time to progression was 3.9 months; median survival was 11.9 months. There was no significant improvement in survival when compared to the RTOG GBM database (with various radiation/drug doublets including BCNU) using recursive partitioning analysis. Historically the incidence of TEE in GBM patients is ∼30%. As this study suggests dalteparin reduces the incidence of TEE, and does not have significant overlapping toxicities with most other drugs, its testing in a combined modality approach with other medications may be warranted in future trials.

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The risk of venous thromboembolism is increased throughout the course of malignant glioma

Cited by 272 publications

References 37 publications

Bevacizumab for recurrent alkylator‐refractory anaplastic oligodendroglioma

Bevacizumab for recurrent alkylator‐refractory anaplastic oligodendroglioma

Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

Effect of dalteparin and radiation on survival and thromboembolic events in glioblastoma multiforme: a phase II ECOG trial

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