Novità dall EHA >> [ Trombosi e cancro ]
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1 Novità dall EHA >> [ Trombosi e cancro ] Relatore: A. FALANGA ottobre 2008 Borgo S. Luigi Monteriggioni (Siena) Trombosi e cancro - Copyright FSE 1
2 TROMBOSI E CANCRO 2 SIMPOSIO EDUCAZIONALE: LMWH and cancer progression (M. Prins) Hemostasis and cancer (FR Rickles) Prophylaxis and treatment of venous thromboembolism in cancer (G. Agnelli) 3 PRESENTAZIONI ORALI 11 POSTER 6 SOLO PUBBLICAZIONE Trombosi e cancro - Copyright FSE 2
3 TROMBOSI E CANCRO 3 SIMPOSIO EDUCAZIONALE: LMWH and cancer progression (M. Prins) Hemostasis and cancer (FR Rickles) Prophylaxis and treatment of venous thromboembolism in cancer (G. Agnelli) Trombosi e cancro - Copyright FSE 3
4 Cancer and Venous Thromboembolism (VTE) 4 VTE is a frequent complication of cancer: Estimated risk is 0.5%/year or 0.04%/month 6.5-fold increased risk with chemotherapy Heit JA et al, Arch Intern Med,2000 Lee AYY, Br J Haematol, 2004 Cancer-associated VTE has several consequences: Increased mortality Increased risk of recurrent VTE as well as bleeding complications Interruption of chemotherapy Economic implications Levitan et al, 1999; Sorensen et al, 2000; Prandoni et al, 2002; Khorana A et al, 2006 Trombosi e cancro - Copyright FSE 4
5 Incidence of VTE in US Cancer Patients: (National Hospital Discharge Survey data. Stein PD et al. Am J Med. 2006) 5 4 Cancer 3 VTE Incidenc ce, % 2 No Cancer Trombosi e cancro - Copyright FSE 5
6 VTE Prevention: Prophylaxis under-utilized 6 Cancer: 2001 FRONTLINE Survey Respondents Kakkar AK et al. Oncologist. 2003;8: Anderson FA et al. Ann Intern Med. 1991;115: Rahim SA et al. Thromb Res. 2003;111: Goldhaber SZ et al. Am J Cardiol. 2004;93: Rashid J Royal Soc Med 2005 Spencer FA et al. Arch Intern Med 2007;167: Tapson VF, et al. Chest 2007;132: Rate of Appropriate Prophylax xis, % Surgical Oncol Medical Oncol US 91 Canada 01 US 02 UK 03 US 07 World 07 Trombosi e cancro - Copyright FSE 6
7 Major Risk Factors 7 Age Primary site of cancer (gastrointestinal, brain, lung, gynecologic, pancreatic, ovarian, renal, bladder, hematologic) History of VTE Hospitalization Major surgery Those receiving active therapy, including chemotherapy, antiangiogenic drugs, and hormonal therapy Metastatic disease Red cell growth factors Trombosi e cancro - Copyright FSE 7
8 Risk Factors for Chemotherapy-associated VTE (Khorana et al., Blood 2008) 8 Low risk: score 0 Intermediate risk: score 1-2 High risk: score < 3 Trombosi e cancro - Copyright FSE 8
9 Guidelines for VTE Prophylaxis and Treatment in Patients with Cancer Released by National and International Scientific Societies 9 AIOM (Società Italiana Oncologia Medica) ASCO (American Society of Clinical Oncology) NCCN (National Comprehensive Cancer Network) ESMO (European Society of Medical Oncology) ACCP (American College of Chest Physicians) IUA (International Union of Angiology) SISET (Società Italiana per lo Studio dell Emostasi e della Trombosi) Trombosi e cancro - Copyright FSE 9
10 Tromboembolismo venoso nel paziente oncologico EHA Abstracts: DIAGNOSI, PROFILASSI, TERAPIA 10 Trombosi e cancro - Copyright FSE 10
11 Tromboembolismo venoso nel paziente oncologico EHA Abstracts: MIELOMA MULTIPLO 11 Trombosi e cancro - Copyright FSE 11
12 Tromboembolismo venoso nel paziente oncologico EHA Abstracts: FATTORI DI RISCHIO 12 Trombosi e cancro - Copyright FSE 12
13 Trombosi idiopatica e cancro occulto 13 I meccanismi di Trombosi sono coinvolti nella crescita e disseminazione tumorale Trombosi e cancro - Copyright FSE 13
14 Tromboembolismo venoso nel paziente oncologico: Abstracts: PATOGENESI 14 Trombosi e cancro - Copyright FSE 14
15 15 Current and future trials to test Anticoagulants to prolong survival Trombosi e cancro - Copyright FSE 15
16 Interface of Tumor Biology and Hemostasis: Thrombosis +/or Bleeding 16 Tumor cells Angiogenesis, Basement matrix degradation. Fibrinolytic activities: t-pa, u-pa, u-par, PAI-1, PAI-2 IL-1, TNF-a, VEGF Procoagulant Activities Activation of coagulation - Tissue Factor (TF) -Factor VII Neutrophils FIBRIN Monocyte Endothelial cells Platelets Trombosi e cancro - Copyright FSE 16
17 Interface of Tumor Biology and Hemostasis: Tumor Growth and Angiogenesis 17 Tumor Cell TF FVII/FVIIa Blood Coagulation Activation VEGF THROMBIN PAR-2 TF FIBRIN Angiogenesis IL-8 Angiogenesis Endothelial cells Falanga and Rickles, New Oncology:Thrombosis, 2005 Trombosi e cancro - Copyright FSE 17
18 Molecular Genetics of Thrombohemorrhagic Syndromes Associated with Human Tumors 18 PAI-1 = plasminogen activator inhibitor-1; COX-2 = cyclooxygenase-2; TF = tissue factor; VEGF = vascular endothelial growth factor; TSP = thrombospondin (Boccaccio et.al. Nature 2005;434:396; Rong et.al. Cancer Res 2005;65:1406; Yu et.al. Blood 2005;105:1734) Trombosi e cancro - Copyright FSE 18
19 Molecular Genetics of Thrombohemorrhagic Syndromes Leukemia and Myeloproliferative Disease 19 APL = acute promyelocytic leukemia; PML/RARalpha = promyelocytic leukemia/retinoic acid receptor alpha gene; TF = tissue factor; ET = essential thrombocythemia; JAK = Janus Kinase gene Cheng et.al. Proc Nat Acad Sci (USA) 1999;96:6318; Falanga et.al. Exp Hematol 2007:35:702 Trombosi e cancro - Copyright FSE 19
Report dei gruppi di lavoro >> [ Trombosi e cancro ]
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