OC 64.5 - Risk of on-treatment recurrent venous thromboembolism in patients with active vs cured cancer patients: a post-hoc analysis of Hokusai VTE cancer

Tuesday, June 27, 2023

15:45 – 16:00 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

Anniek Strijdhorst, MD (she/her/hers)

Department of Vascular Medicine, AmsterdamUMC, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands

Co-Author(s)

HB

Harry R. Büller

MD
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
Gary E. Raskob, PhD

MD
University of Oklahoma Health Sciences Center, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, United States
Oklahoma City, Oklahoma, United States
MG

Michael Grosso

MD
Daiichi Sankyo Pharma Development, Basking Ridge, New Jersey, United States
Basking Ridge, New Jersey, United States
AS

Annelise Segers

MD
ITREAS, Academic Research Organization, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
MD

Marcello Di Nisio

MD
Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy
Chieti, Abruzzi, Italy
Nick van Es, MD PhD (he/him/his)

MD
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands

Background: Trials evaluating anticoagulation for cancer associated thrombosis have used a uniform, broad definition of active cancer, which encompasses patients with local or metastatic cancer, but also those who can be considered cured after surgical resection or other curative treatment.
We hypothesized that the incidence of recurrent venous thromboembolism (VTE) would differ between these groups, which might support a different management and more narrow definition of active cancer.

Aims: To evaluate the incidence of on-treatment recurrent VTE in patients with acute VTE stratified by components of the active cancer definition.

Methods: This was a post-hoc analysis of Hokusai VTE Cancer, an open-label randomized controlled trial comparing edoxaban with dalteparin for the treatment of acute cancer-associated VTE. We classified patients with solid cancer into three groups at time of VTE index event: active cancer with distant metastasis active cancer without metastasis, and cured cancer after surgery or other treatment, without measurable disease. The primary outcome was recurrent VTE during 6-month follow-up.

Results: Of the 919 patients with solid cancer in the modified intention-to-treat analysis, 546 (59%) had metastatic disease distant metastasis. 151 (n=16%) had solid cancer without metastasis, and 222 (n=24%) had received treatment with curative intent (Table 1). Recurrent VTE occurred in 53 patients (10%) with metastatic disease, 8 (5%) in patients with cancer without metastasis, and 13 (6%) in patients considered cured. Compared to patients with metastatic disease, the risk of recurrent VTE was significantly lower in those considered cured (HR, 0.51; 95%-CI, 0.28-0.94) (Figure 1).

Conclusion(s): Patients with acute VTE and solid cancer after treatment with curative intent were at significantly lower risk of recurrent VTE than those with distant metastasis. However, the risk of recurrence in the former group was still substantial, which probably does not justify shorter or less intensive anticoagulant treatment.

Learning Objectives:

Upon completion, participant will be able to effectively evaluate the recurrent risk of VTE in individual patients by considering the presence or absence of residual tumor cells.
Upon completion, participant will be able to recall the incidence of on-treatment recurrent VTE risk and bleeding risk in cancer patients treated with direct oral anticoagluation for VTE.
Upon completion, participant will be able endorse heterogenity in the active cancer classification that is currently used in VTE trials.