Cancer-Associated Thrombosis: New Findings in Translational Science, Prevention, and Treatment PDF

Preface

The study of hemostasis in cancer is an exciting area of research that involves investigators from disparate fields including molecular biology, hematology, oncology, and epidemiology. The results of investigations in this area have direct implications for cancer patients and their providers, including medical and surgical oncologists, hematologists, internists, and hospitalists.

The field has seen an explosion of research in recent years. Five developments are particularly noteworthy. First, we understand more fully that the coagulation cascade is inextricably linked with tumor biologic processes, in particular tumor angiogenesis, and that the hypercoagulable state is under oncogene regulation. Tissue factor is an excellent example of this linkage, and its importance in both thrombosis and angiogenesis in cancer is being increasingly recognized. Second, the burden of cancer-associated thrombosis has been increasing since the late 1990s and likely will continue to rise with the advent of anti-angiogenic therapy. Oncologists in particular have become more aware of this problem because of the vascular toxicity of regimens containing anti-angiogenic drugs. Third, we are able to identify risk factors predictive of cancer-associated thrombosis; this enhances the clinician's ability to stratify patients and develop effective prophylaxis strategies. Fourth, low-molecular-weight heparins are playing an increasingly important role in both prevention and treatment of this illness. These drugs appear to be more effective than older anticoagulants and may also impact tumor outcomes and survival in cancer patients. Other new anti-thrombotics are in development as well. Finally, two major United States cancer panels-the American Society of Clinical Oncology (ASCO) VTE Guidelines Panel and the National Comprehensive Cancer Network Practice Guidelines on Venous Thromboembolic Disease-are in the midst of releasing guidelines on this subject. These represent the first guidelines on this topic issued by the US oncology community and reflect the increasing need for guidance in treating this difficult illness.

In this book we present a synthesis of this new literature and place it in its proper context. We are pleased that all of the chapters are written by internationally renowned experts in their respective fields, including the co-chairs and many other members of the ASCO VTE Guidelines Panel. Together, these authors have collaborated to provide a comprehensive, balanced, and thought-provoking perspective on state-of-the-art research in this area. In addition, the authors have provided executive summaries highlighted in a box at the beginning of each chapter. We hope these will provide a useful reference tool for practitioners and that this book will be of interest not only to hematologists and oncologists but also to internists, surgeons, hospitalists and midlevel providers, all of whom provide care to the many cancer patients with thromboembolism.