Abstract
Exocrine pancreatic ductal adenocarcinoma, simply referred to as pancreatic cancer (PC) has the worst prognosis of any malignancy. Despite recent advances in the use of adjuvant chemotherapy in PC, the prognosis remains poor, with fewer than 8% of patients being alive at 5 years after diagnosis. The prevalence of PC has steadily increased over the past decades, and it is projected to become the second-leading cause of cancer-related death by 2030. In this context, optimizing and integrating supportive care is important to improve quality of life and survival. Venous thromboembolism (VTE) is a common but preventable complication in PC patients. VTE occurs in one out of five PC patients and is associated with significantly reduced progression-free survival and overall survival. The appropriate use of primary thromboprophylaxis can drastically and safely reduce the rates of VTE in PC patients as shown from subgroup analysis of non-PC targeted placebo-controlled randomized trials of cancer patients and from two dedicated controlled randomized trials in locally advanced PC patients receiving chemotherapy. Therefore, primary thromboprophylaxis with a Grade 1B evidence level is recommended in locally advanced PC patients receiving chemotherapy by the International Initiative on Cancer and Thrombosis clinical practice guidelines since 2013. However, its use and potential significant clinical benefit continues to be underrecognized worldwide. This narrative review aims to summarize the main recent advances in the field including on the use of individualized risk assessment models to stratify the risk of VTE in each patient with individual available treatment options.
Highlights
Exocrine pancreatic ductal adenocarcinoma (PDAC), often referred to as pancreatic cancer (PC) is a malignancy with the highest mortality rate of any solid cancer and with a growing incidence, partly due to aging of the population and improvements in diagnostic techniques [1,2]
We recently investigated the incidence and risk factors for Venous thromboembolism (VTE) in the BACAP-VTE study, a large prospective multicenter cohort of patients with histologically proven PC
PC patients receiving primary thromboprophylaxis with either low molecular weight heparin (LMWH) or a Direct Oral Anticoagulants (DOAC) had significantly lower rates of VTE compared to controls (5.43% vs. 12.07%, relative risk (RR) 0.44, 95% confidence interval (CI) 0.29–0.70), with a risk difference of −0.06 with no difference in the rate of major bleeding between the two groups (4.11% vs. 3.27%) [100]
Summary
Exocrine pancreatic ductal adenocarcinoma (PDAC), often referred to as pancreatic cancer (PC) is a malignancy with the highest mortality rate of any solid cancer and with a growing incidence, partly due to aging of the population and improvements in diagnostic techniques [1,2]. 15–20% of PC patients have a potentially resectable tumor at diagnosis, while most patients have locally advanced tumors and over 50% have metastatic disease, due to a lack of early symptoms or available biological markers, with a life expectancy of less than one year [2,6]. Conroy et al showed that adjuvant therapy with a modified FOLFIRINOX regimen led to significantly longer survival than gemcitabine (GEM) monotherapy among patients with resected. Despite recent advancements, prognosis remains poor, with few patients surviving to 10 years [7]. In this context, there is a need for optimizing and integrating supportive care in the management of PC patients to improve survival and quality of life. Initiative (ITAC) clinical practice guidelines (CPGs) since 2013 [12,13,14] and more recently by the American Society of Clinical Oncology (ASCO) guidelines [15], the use of primary thromboprophylaxis, a supportive treatment with potential significant clinical benefit, continues to be underrecognized [16]
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