JS4-1 - Three cases of venous thromboembolism in advanced cancer patients

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Background: The incidence of venous thromboembolism (VTE) in cancer patients is high and the symptoms of VTE observed in daily practice are varied. Here we report three cases of VTE treated at Department of Medical Oncology in Tohoku University. Case 1: A 42-year-old man diagnosed with urachal carcinoma had received FOLFIRI for 10 months. He felt his shortness of breath became strong for several weeks. Computed tomography (CT) revealed pulmonary embolism, thus he was hospitalized urgently. Heparin was administered for 1 week, and then direct oral anticoagulant (DOAC) was started. His shortness of breath was improved and CT showed the reduction of embolism, therefore he discharged 13 days after treatment started. CT after 3 months was confirmed the loss of thrombus and recurrence was not observed. Clinically relevant bleeding was not observed, therefore chemotherapy could be continued smoothly. Case 2: A 61-year-old man diagnosed with rectal cancer had received bevacizumab + FOLFIRI for 2 months. An asymptomatic thrombus around the catheter of central venous access port was accidently pointed out by CT to evaluate the effect of chemotherapy. DOAC was administered, and then CT examination after 1 months was confirmed the loss of thrombus. Recurrence was not observed and clinically relevant bleeding was not observed. Case 3: A 51-year-old man diagnosed with rectal cancer had received cetuximab + FOLFIRI for 2 months. His performance status was poor due to tumor progression and adverse events of chemotherapy. Pulmonary embolism was detected by CT to evaluate the effect of chemotherapy, thus he was hospitalized urgently and heparin and warfarin were administered. His prothrombin time-international normalized ratio did not remain within the target range, therefore DOAC was administered. However, the bleeding of his stoma was observed after 10 days, DOAC was discontinued. Anticoagulant therapy was never performed after that because of his poor systemic condition.