Thrombotic events in patients with cancer receiving antiangiogenesis agents.
Tumor-associated neoangiogenesis has recently become a suitable target for antineoplastic drug development. In this overview, we discuss specific drug-associated hemostatic complications, the already known pathogenetic mechanisms involved, and the effect of varying antithrombotic strategies. Multiple agents with angiogenic inhibitory capacity (thalidomide, lenalidomide, bevacizumab, sunitinib, sorafenib, and sirolimus) have obtained US Food and Drug Administration approval, and many others have entered clinical trials. Arterial and venous thromboembolism and hemorrhage have emerged as significant toxicities associated with the use of angiogenesis inhibitors. We present a detailed analysis of the literature on thrombotic complication of antiangiogenic drugs. Close attention to hemostatic complications during antiangiogenic treatment is warranted. Further studies are required to better understand the pathophysiologic mechanisms involved and to define a safe prophylactic strategy.
Zangari
Maurizio
M
University of Utah, Division of Hematology, Blood/Marrow Transplant and Myeloma Program, Salt Lake City, UT, USA. maurizio.zangari@hsc.utah.edu
Fink
Louis M
LM
Elice
Francesca
F
Zhan
Fenghuang
F
Adcock
Dorothy M
DM
Tricot
Guido J
GJ
D020533:Angiogenesis Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D013792:Thalidomide / Q000009:adverse effects / Q000627:therapeutic use; D013923:Thromboembolism / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology*
D020533:Angiogenesis Inhibitors; D000925:Anticoagulants; D007155:Immunologic Factors; D013792:Thalidomide