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Hamostaseologie
DOI: 10.1055/a-2420-7684
Review Article

Treatment of Cancer-Associated Thrombosis: An Update

Minna Voigtlaender
1   Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Christina Rolling
1   Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Christina Hart
2   Department of Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
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Abstract

Patients with cancer are at increased risk of venous thromboembolism (VTE). Treatment of VTE remains challenging due to a significant risk of both VTE recurrence and bleeding compared with patients without underlying malignancy. Moreover, patients with cancer often present with several comorbidities such as tumor- or treatment-induced bone marrow failure, renal impairment, and extensive concomitant anticancer or supportive medication, resulting in potential drug–drug interactions. Further challenging circumstances include gastrointestinal (GI) disorders, in the context of a GI intraluminal tumor itself, GI surgery, or systemic therapy-induced GI toxicity. However, treatment options and study data in the management of cancer-associated thrombosis (CAT) have expanded over the last few years. As a result, it is becoming increasingly important to assess the patient's individual risk of bleeding and its comorbidities, and the patient's personal preferences. Prospectively, further therapeutic strategies such as factor XIa inhibitors are under clinical investigation. The aim of our narrative review is to summarize the current literature on therapy options for CAT, including common treatment situations encountered in the management of patients with cancer.

Zusammenfassung

Tumorpatienten weisen ein gesteigertes Risiko für die Entwicklung von venösen Thromboembolien (VTE) auf. Aufgrund des erhöhten Rezidiv- und Blutungsrisiko stellt die Behandlung von tumor-assoziierten Thromboembolien oft eine Herausforderung dar. Darüber hinaus haben Tumorpatienten oft relevante Begleiterkrankungen wie eine Tumor- oder Therapie-vermittelte Beeinträchtigung der Hämatopoese, eine eingeschränkte Nierenfunktion und/oder eine umfangreiche Anti-Tumor- oder Begleitmedikation, die in Arzneimittel-Wechselwirkungen resultieren kann. Ferner sind häufig gastrointestinale (GI) Störungen zu berücksichtigen, entweder durch intraluminal gelegene GI-Tumore, chirurgische abdominelle Eingriffe oder zytotoxische Effekte der Krebstherapie auf den GI-Trakt. Erfreulicherweise wurden in den letzten Jahren weitere Therapieoptionen und Studienergebnisse in der Behandlung tumor-assoziierter Thromboembolien aufgezeigt. Entsprechend sollte in der Therapieauswahl einer tumor-assoziierten VTE der Fokus verstärkt auf die Einordnung des individuellen Blutungsrisikos, der Komorbiditäten und der jeweiligen Patientenpräferenz liegen. Gegenwärtig werden neue Therapieansätze wie Faktor XIa-Inhibitoren in klinischen Studien getestet. Das Ziel unseres Reviews ist es, die aktuelle Literatur zu Therapieoptionen der tumorassoziierten VTE einschließlich häufig auftretender Herausforderungen in der Behandlung von Tumorpatienten zusammenzufassen und einzuordnen.

Keywords

cancer - thrombosis - treatment - anticoagulants - bleeding

Schlagwörter

Tumor - Thrombose - Antikoagulation - Blutung

Authors' Contributions

M.V. and C.H. wrote the manuscript draft. All authors contributed to the manuscript drafting, reviewed, and approved the final version.




Publication History

Received: 05 August 2024

Accepted: 24 September 2024

Article published online:
05 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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