Safety of direct oral anticoagulants in patients with advanced solid tumors receiving anti-VEGF agents: a retrospective study.
Alice BoilèveLaurence AlbigesMichel DucreuxEric BaudinAlexandra LearyBenjamin BesseJulien HadouxDavid MalkaAndré RieutordFlorian ScottéAmandine MaulardOlivier MirPublished in: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
Of 92 patients (median age 66 years (IQR: 59-72)), 40 were treated with KI and 52 with bevacizumab. The most frequent primary tumor sites were colon/rectum (24%), kidney (21%), ovary (13%), lung (11%), soft tissue sarcoma (10%), and thyroid (9%); 2% had brain metastases. Apixaban 5 mg bid (n = 41) or rivaroxaban 20 mg daily (n = 51) were given for TE (65%), atrial fibrillation (32%), or other indications (3%). The median duration of concomitant treatment was 4.8 months (95%CI: 0.7-50.0) with bevacizumab and 11.7 months (95%CI: 0.1-53.8) with KI. Grade ≥ 3 bleeding events occurred in 5 patients (5%): 4 patients receiving bevacizumab (one grade 5 upper digestive tract bleeding and three grade 3 rectal or vaginal hemorrhages) and 1 patient under cabozantinib for kidney cancer with endobronchial metastasis (grade 3 hemoptysis). Grade ≥ 3 TE occurred in 8 patients (9%): 7 patients receiving bevacizumab (including one grade 5 pulmonary embolism), and one patient receiving sunitinib (grade 3 pulmonary embolism). Median time-to-event (bleeding or thrombotic event) was not reached (NR) (95%CI: 76.9-NR) for KI and 86.9 months (95%CI: 42.9-148.0) for bevacizumab. CONCLUSIONS AND RELEVANCE: In our experience, the use of DOAC was safe in selected patients treated with KI, but unclear with bevacizumab. More data are needed to endorse guidelines in this specific group of patients.
Keyphrases
- pulmonary embolism
- atrial fibrillation
- end stage renal disease
- direct oral anticoagulants
- newly diagnosed
- ejection fraction
- venous thromboembolism
- heart failure
- prognostic factors
- small cell lung cancer
- squamous cell carcinoma
- inferior vena cava
- case report
- left ventricular
- metastatic colorectal cancer
- acute coronary syndrome
- brain metastases
- lymph node
- smoking cessation
- deep learning
- vascular endothelial growth factor
- left atrial
- electronic health record
- ultrasound guided
- left atrial appendage
- clinical practice
- lymph node metastasis