2) Program support from an unrestricted educational grant from Anthos Therapeutics. Statement of accreditation & faculty disclosures at https://t.co/8oShcATovC. Earn 0.5 hr 🆓 CE/#CME by following this 🧵, & follow @onc_ce for more expert-led #MedEd. #OncTwitter #FOAMed #ONCSM
— @onc_ce (@onc_ce) September 19, 2023
4) #CAT is associated with significant morbidity (delays in #chemotherapy and #surgery) and 2⃣nd leading cause of ☠️ in patients with #cancer. Patients with #CAT are more likely to have recurrent #VTE and 🩸 #bleeding compared to patients without cancer.
— @onc_ce (@onc_ce) September 19, 2023
5b) However, LMWH is 💲💲 and requires daily or twice daily 💉. LMWH is associated with 📉persistence over time and 📈 risk of early discontinuation compared to oral anticoagulants.https://t.co/tlC5lHUymG pic.twitter.com/ndxoBZlANz
— @onc_ce (@onc_ce) September 19, 2023
7) @ASH_hematology and @ASCO #VTE guidelines are suggesting to use DOACs in #CAT except in those at ⬆️ risk of 🩸 bleeding (especially unresected GI and GU #cancer) or with clinically important drug-to-drug interactions (#DDIs).https://t.co/a4bjGn49yG
— @onc_ce (@onc_ce) September 19, 2023
9) Hence, many remaining unmet needs related to current anticoagulants for the management of #CAT: 1) ⬆️ risk of bleeding; 2) renal and hepatic dysfunction; 3) DDIs; and 4) persistence to anticoagulation.https://t.co/JBNXk3PSKO pic.twitter.com/zDCYfGChn0
— @onc_ce (@onc_ce) September 19, 2023
10b) WHY? #FXI is a key component in intrinsic pathway. #Cancer can initiate the intrinsic pathway (#FXIIa) and generate #thrombin (Tissue Factor (#TF)). FXI is activated by thrombin or FXIIa. Feedback activation of FXI amplifies thrombin generation.https://t.co/XI7A2VuFks pic.twitter.com/EaLqZgkmb5
— @onc_ce (@onc_ce) September 19, 2023
11a) 4⃣ FXI inhibitors are currently being investigated for different indications: 1⃣ antisense oligonucleotide #ASO (#fesomersen); 2⃣ monoclonocal antibodies #MAbs (#abelacimab and #osocimab); and 2⃣ small molecules (#milvexian and #asundexian).
— @onc_ce (@onc_ce) September 19, 2023
12) Abelacimab is a humanized monoclonal antibody that binds FXI and prevents its activation by FXIIa and thrombin. Parenteral administration 💉 + rapid and dose dependent FXI inhibition + Half-life: 2⃣0⃣ days.https://t.co/COWrA6Nvxs
— @onc_ce (@onc_ce) September 19, 2023
14) 2⃣ RCTs are assessing the efficacy and safety of #abelacimab for the management of #CAT.
— @onc_ce (@onc_ce) September 19, 2023
· #ASTER (NCT 05171049): Abelacimab vs. apixaban
· #MAGNOLIA (NCT 05171075): Abelacimab vs. #LMWH (Dalteparin) in patients with GI and GU tumors
15b) In addition, the risk of bleeding is higher in GI & GU cancers because of the presence of intraluminal tumors. See 🔓 https://t.co/3n72PkIW0G
— @onc_ce (@onc_ce) September 19, 2023
17a) So what have we learned? Which of the following IS NOT true regarding the management of #CAT?
— @onc_ce (@onc_ce) September 19, 2023
a. LMWH more effective than warfarin
b. LMWH more effective than DOACs
c. DOAC similar major🩸 bleeding than LMWH
d. Guidelines suggest DOACs for most #CAT
17c) It's a. We can add #liver dysfunction & better persistence on #anticoagulation. Factor XI inhibitors may provide a potential novel approach to address current unmet needs and on-going trials (#ASTER and #MAGNOLIA) may help to optimize management of #CAT.
— @onc_ce (@onc_ce) September 19, 2023
18) You just earned 0.5hr 🆓CE/#CME! Grab your certificate for credit at https://t.co/oNslBQGhmZ, and follow us here on @onc_ce for more education on this & other topics related to #cancer, #CAT, #Cancer & #VTE! @MarcCarrier1 & @aakonc 🙏for joining!
— @onc_ce (@onc_ce) September 19, 2023