Abstract
Venous thromboembolism (VTE) is a frequent complication of cancer, and management
of cancer-associated thrombosis (CAT) is challenging due to increased risks of bleeding
and recurrent VTE. Recent trials have shown an acceptable efficacy and safety of direct
oral anticoagulants (DOACs) in the treatment of CAT compared to low-molecular weight
heparin. Although DOACs provide an effective and convenient treatment option in CAT,
the need to assess the risk of drug–drug interactions (DDI) with antineoplastic therapies
poses a barrier to their use in clinical practice. With the aim of supporting the
assessment of CAT patients for treatment with DOAC, this review provides a comprehensive
overview of the compatibility of antineoplastic therapies with the individual DOACs
(apixaban, dabigatran, edoxaban, and rivaroxaban). Using several data sources, we
characterized 100 widely used antineoplastic agents with regard to their effect on
p-glycoprotein and cytochrome P450, both important in the transport and elimination
of DOACs. This enabled us to evaluate 400 “DOAC-antineoplastic agent”-pairs regarding
their likelihood to interact (unlikely, potential, or likely), ultimately leading
to clinical recommendations on the appropriateness of concomitant use for each pair.
A potential or likely DDI was identified for 12% of the evaluated pairs. For nearly
all antineoplastic agents, at least one DOAC was considered compatible.
Keywords
anticoagulants - cancer - drug interactions - venous thromboembolism
