1b) Our expert co-faculty are Tzu-Fei Wang MD @TzufeiWang, #thrombosis & benign #shematologist from @OttawaHospital and founding @onc_ce faculty Alok Khorana MD @aakonc, Hardis Endowed Chair, Prof Med, Vice Chair Taussig Cancer Inst, Dir GI Cancers, @ClevelandClinic pic.twitter.com/jKzhDBw1Ly
— @onc_ce (@onc_ce) September 25, 2023
3) Let's start with the basics. Patients with #cancer have a 12X increased risk of VTE compared to those without cancer, with the risk further increased to 23X with #anticancer therapy.
— @onc_ce (@onc_ce) September 25, 2023
🔓 https://t.co/4sgmgoVNkn pic.twitter.com/jesSuUnuvz
5) In 2003, #CLOT was the first pivotal #RCT in #CAT to show that #LMWH is superior to #VKA in preventing recurrent VTE without an increased risk of bleeding 🩸.
— @onc_ce (@onc_ce) September 25, 2023
🔓 https://t.co/THDX0NfdNk pic.twitter.com/Db5AkfGAFu
6b) https://t.co/90Mx2L6wHl
— @onc_ce (@onc_ce) September 25, 2023
Safety: pic.twitter.com/HOVuJ4ILiT
8)
— @onc_ce (@onc_ce) September 25, 2023
👉#Select_D trial (N=406) https://t.co/e4PZsERVST
👉#CASTA_DIVA trial (N=158) https://t.co/oh9bDffHQX
These compared #rivaroxaban to #dalteparin. Rivaroxaban was associated with an increased risk of #CRNMB in Select-D. pic.twitter.com/rlcMVKt3rP
10) Same comparison, similar results in #ADAM_VTE trial (N=300)
— @onc_ce (@onc_ce) September 25, 2023
🔓 https://t.co/djVKk1mTZq pic.twitter.com/XSVGI1m50k
12a) So where are we?
— @onc_ce (@onc_ce) September 25, 2023
👉Major international guidelines rec #DOACs or #LMWH as anticoagulants of choice for #CAT.
👉DOACs might be preferred except for pts at ⬆️risk of 🩸(such as unresected luminal GI and GU #cancer) or with clinically important drug-drug interactions #DDIs. pic.twitter.com/Oo6OfafzJm
13) In patients with well-managed #CAT and active #cancer, how should we treat after 6 months of #anticoagulation?
— @onc_ce (@onc_ce) September 25, 2023
👉#Guidelines rec continued anticoagulants as long as cancer is active, but full vs reduced dose of anticoagulation is debatable. pic.twitter.com/mMx2pkxMKZ
14b) Results #EVE, apixaban 2.5mg BID vs 5mg BID:
— @onc_ce (@onc_ce) September 25, 2023
👉12mo risk of MB+CRNMB: 8.9% vs 12.2%, HR 0.72, 95% CI 0.38-1.37
👉12mo risk of recurrent VTE: 5.0% vs 4.4%, HR 1.00, 95% CI 0.40 – 2.53)
Small study but encouraging results pic.twitter.com/JdtVGyLXlF
15b) #API_CAT is an international, randomized, parallel-group, double-blind, noninferiority trial with blinded adjudication of outcome events. Consecutive patients are randomized to receive #apixaban 2.5 or 5 mg bid for 12 months.
— @onc_ce (@onc_ce) September 25, 2023
16a) That is likely the top of the 🗻for #DOACs in #CAT. Problem is, many pts with active #cancer aren't well-suited for #DOACs because ⬆️ risk of 🩸 bleeding (especially unresected GI and GU #cancer) or with clinically important drug-to-drug interactions (#DDIs).
— @onc_ce (@onc_ce) September 25, 2023
17a) Factor XI (#FXI) inhibitors have the potential to be safer than DOACs
— @onc_ce (@onc_ce) September 25, 2023
👉⬆️FXI levels are associated with ⬆️ risk of #VTE.
👉Congenital FXI deficiency is not associated with ⬆️ risk of 🩸
🔑 FXI may be an attractive target for #CAT.
18a) 4⃣ FXI inhibitors are currently being investigated for different indications: 1⃣ antisense oligonucleotide #ASO (#fesomersen); 2⃣ monoclonal antibodies #MAbs (#abelacimab and #osocimab); and 2⃣ small molecules (#milvexian and #asundexian).
— @onc_ce (@onc_ce) September 25, 2023
19) 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 25, 2023
21) 2⃣ RCTs, comparator-controlled, are assessing the efficacy & safety of #abelacimab for the management of #CAT.
— @onc_ce (@onc_ce) September 25, 2023
👉#ASTER (NCT 05171049): Abelacimab vs. apixaban
👉#MAGNOLIA (NCT 05171075): Abelacimab vs. #LMWH (#dalteparin) in patients with GI and GU tumors
23) Potential challenges with #abelacimab in patients with #cancer
— @onc_ce (@onc_ce) September 25, 2023
👉Management of bleeding episodes (antifibrinolytic agents? low dose FVIIa?)
👉Management of recurrent #VTE
👉Management of thrombocytopenia
👉Peri-operative management
🚨 Stay tuned!
24b) It's b, a #LMWH, and #dalteparin is most often used in clinical trials. These patients have among the highest 🩸risk in the #CAT world.
— @onc_ce (@onc_ce) September 25, 2023
Now, which of the following IS NOT a remaining unmet need for the management of #CAT?
25) You just earned 0.5hr 🆓CE/#CME! Grab your certificate for credit at https://t.co/M4PS9tVLjQ, and follow us here on @onc_ce for more education on this & other topics related to #cancer, #CAT, #Cancer & #VTE! @TzufeiWang & @aakonc thank you for joining us!
— @onc_ce (@onc_ce) September 25, 2023