In a webinar that was held World Thrombosis Day 2022, two coagulation experts—Prof Anna Falanga, Professor of Hematology at University of Milan Bicocca, and Cinzia Giaccherini, a research biologist with more than 10 years of experience in hemostasis and thrombosis—discussed the predictive role of biomarkers in cancer-associated thrombosis (CAT).

Prof Anna Falanga began by presenting an overview of CAT risk prediction and prevention. UK and Danish cohort studies demonstrated that patients with cancer have a 4–11-fold increased risk for venous thromboembolism (VTE) as compared with non-cancer patients, depending on cancer type; with VTE affecting morbidity and mortality in cancer patients.

In order to prevent VTE, high-risk cancer patients who may benefit from primary thromboprophylaxis need to be identified. Risk assessment modules (RAMs) such as the Khorana score can predict VTE risk in patients. RAMs can be augmented with biomarkers to improve prediction.

Cinzia Giaccherini then discussed biomarkers for CAT prediction and disease prognosis in lung cancer. Coagulation biomarkers such as D-dimer were noted as potentially useful in evaluating a patient’s individual thrombotic risk. There is evidence for supporting their use in lung cancer patients, in which they could also be indicative of poor prognosis.

Several studies reported a significant association between elevated D-dimer plasma levels and large tumour burden, disease progression and mortality. Further investigations are needed to strengthen the current evidence and to encourage the future use of coagulation biomarker-based models in clinical practice.

During the Q&A session, pulmonary embolism was noted as being most common among lung cancer patients, with diagnosis often found while screening for the cancer. Concerning edoxaban treatment with VTE, it was recommended to continue treatment for 12 months with the same dose before adjusting if VTE remains.

D-dimer was noted as being a promising marker for VTE and a predictor of disease prognosis. It was suggested that a more aged population and newer cancer treatments could be linked to the increasing thrombosis risk in all cancer types.

Prof Anna Falanga, MD, is Professor of Hematology at University of Milan Bicocca and Chief of the Department of Immunohematology and Transfusion Medicine and the Thrombosis and Hemostasis Center at the Hospital Papa Giovanni XXIII, in Bergamo, Italy. She has authored more than 300 publications and is guest editor of 21 volumes, and she is an expert in the field of cancer and thrombosis.

Cinzia Giaccherini is a research biologist with more than 10 years of experience at the Hemostasis and Thrombosis Laboratory of the Immunohematology and Transfusion Medicine division at Papa Giovanni XXIII Hospital in Bergamo (Italy). She is also attending a postgraduate specialisation in Medical Statistics and Biometrics at the University of Milan.

Additional resources:
[1] Falanga, A. et al. (2022) “How well do European patients understand cancer-associated thrombosis? A patient survey,” Cancer Treatment and Research Communications, 31, p. 100557. Available at: https://doi.org/10.1016/j.ctarc.2022.100557.

[2] Falanga, A. et al. (2021) “Management of cancer-associated thrombosis: Unmet needs and future perspectives,” TH Open, 05(03). Available at: https://doi.org/10.1055/s-0041-1736037.

[3] Falanga, A. et al. (2022) “Thrombotic complications in patients with cancer: Advances in pathogenesis, prevention, and treatment—a report from ICTHIC 2021,” Research and Practice in Thrombosis and Haemostasis, 6(5). Available at: https://doi.org/10.1002/rth2.12744.

[4] Pesenti, M. et al. (2020) “Thrombin generation and D-dimer significantly predict for early disease progression and mortality in patients with gastrointestinal cancer,” Blood, 136(Supplement 1), pp. 32–32. Available at: https://doi.org/10.1182/blood-2020-136631.

[5] Falanga, A. et al. (2019) “Thrombotic risk assessment in a prospective cohort of newly diagnosed ambulatory cancer patients candidate to Chemotherapy,” Blood, 134(Supplement_1), pp. 3642–3642. Available at: https://doi.org/10.1182/blood-2019-129901.