Treatment of Cancer-Associated Thrombosis: Recent Advances, Unmet Needs, and Future Direction.
Treatment of Cancer-Associated Thrombosis: Recent Advances, Unmet Needs, and Future Direction.
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DOI：
10.1093/oncolo/oyad116
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发表时间：
2023-07-05
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癌症相关血栓形成的发病率逐年上升，与癌症患者的发病率和死亡率显著相关。癌症相关静脉血栓栓塞（VTE）治疗的最新进展包括引入直接口服抗凝剂（DOAC），这提供了比低分子量肝素（LMWH）更方便和有效的选择。尽管如此，仍存在重要的未满足需求，包括某些患者亚组（如胃食管癌患者）出血风险增加、药物相互作用问题以及重度肾损害患者的管理。虽然DOAC比LMWH更方便，但持久性会随着时间的推移而下降。因子XI抑制剂相对于DOAC具有潜在的安全性优势，因为因子XI似乎对血栓形成而非止血至关重要。在II期试验中，某些因子XI抑制剂在预防膝关节置换术后VTE方面上级依诺肝素，而不会增加出血风险。正在进行的试验正在评估因子XI抑制剂治疗癌症相关性VTE的疗效和安全性。本综述总结了癌症相关静脉血栓栓塞治疗的进展，概述了目前治疗中未满足的关键需求，并讨论了因子XI抑制剂如何解决目前的知识缺口。
Cancer-associated thrombosis, with the incidence rising over the years, is associated with significant morbidity and mortality in patients with cancer. Recent advances in the treatment of cancer-associated venous thromboembolism (VTE) include the introduction of direct oral anticoagulants (DOACs), which provide a more convenient and effective option than low-molecular-weight heparin (LMWH). Nonetheless, important unmet needs remain including an increased risk of bleeding in certain patient subgroups such as those with gastroesophageal cancer, concerns about drug-drug interactions, and management of patients with severe renal impairment. Although DOACs are more convenient than LMWH, persistence can decline over time. Factor XI inhibitors have potential safety advantages over DOACs because factor XI appears to be essential for thrombosis but not hemostasis. In phase II trials, some factor XI inhibitors were superior to enoxaparin for the prevention of VTE after knee replacement surgery without increasing the risk of bleeding. Ongoing trials are assessing the efficacy and safety of factor XI inhibitors for the treatment of cancer-associated VTE. This narrative review summarizes advances in the treatment of cancer-associated venous thromboembolism, outlines key unmet needs with the current treatment, and discusses how factor XI inhibitors may address the current knowledge gaps.
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DOI：
10.1056/nejmoa1405760
发表时间：
2015-01-15
期刊：
The New England journal of medicine
影响因子：
--
作者：
Büller HR;Bethune C;Bhanot S;Gailani D;Monia BP;Raskob GE;Segers A;Verhamme P;Weitz JI;FXI-ASO TKA Investigators
通讯作者：
FXI-ASO TKA Investigators
影响因子：
45.3
作者：
Key, Nigel S.;Khorana, Alok A.;Falanga, Anna
通讯作者：
Falanga, Anna
影响因子：
9.6
作者：
Kearon, Clive;Akl, Elie A.;Moores, Lisa
通讯作者：
Moores, Lisa
影响因子：
--
作者：
Heit, JA;Mohr, DN;Melton, LJ
通讯作者：
Melton, LJ
影响因子：
6.7
作者：
Cohen, Alexander T.;Katholing, Anja;Martinez, Carlos
通讯作者：
Martinez, Carlos