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Parenteral anticoagulation in ambulatory patients with cancer

Cochrane Review:

18 trials including 9575 participants with cancer. Most trials included participants with various types of cancer, especially small cell lung cancer, non-small cell lung cancer, and pancreatic cancer. All studies were conducted in the outpatient setting.

The results suggest that the effect of injectable blood thinners on survival is uncertain, but if anything of small size.

Also the results suggest that injectable blood thinners reduce the risk of blood clots by about half and possibly increase the risk of major bleeding and minor bleeding by 4 more per 1000 and 17 more per 1000, respectively.

The effect on quality of life is uncertain.

Certainty of evidence was judged to be high for symptomatic VTE and minor bleeding, and moderate for mortality, major bleeding and quality of life.

Read the full Cochrane Review here

First‐line treatment of advanced non‐small cell lung cancer identified as being EGFR mutation positive

Background

Lung cancer is the most common cancer in the world. It has often spread by the time it is diagnosed. Therefore, surgery is usually not possible and drug treatment, typically chemotherapy, is needed. The commonest type of lung cancer is non‐small cell lung cancer (NSCLC). Around 10% to 15% of people with NSCLC will have a specific kind of cancer known as epidermal growth factor receptor positive (EGFR M+), in which there are changes in the cancer cells to the genes controlling tumour growth.

Objectives

The purpose of this review was to find out whether people given treatments targeted at EGFR M+ NSCLC live longer and have a better health‐related quality of life than people having standard chemotherapy.

Trial characteristics

We found 22 trials that looked at five different EGFR‐targeted drugs and compared them with standard chemotherapy treatment: erlotinib, gefitinib, afatinib, icotinib and the antibody cetuximab. We included trials reporting results up to 27 July 2020.

Results

Our results showed that people given erlotinib, gefitinib, afatinib or icotinib have a longer time before the cancer progresses and experience fewer side effects than those people given standard chemotherapy. However, we could not be sure whether people given erlotinib, afatinib or icotinib live any longer than those given standard chemotherapy.

Conclusion

Erlotinib, gefitinib, afatinib and icotinib delay further spread of EGFR M+ lung cancer and improve health‐related quality of life. Giving cetuximab with chemotherapy is no better at controlling this type of cancer or extending life than chemotherapy alone.

Cochrane Review; including 15 studies 1615 participants with cancer and VTE

Background

People with cancer are at increased risk of blood clots. The blood thinner (anticoagulant) administered in the first few days after identifying a blood clot can consist of unfractionated heparin (infused through a vein), low molecular weight heparin (injected under the skin once or twice per day; dalteparin, and tinzaparin are two different types of low molecular weight heparin), or fondparinux (injected under the skin once daily). These blood thinners may have different effectiveness and safety profiles.

Key results

Data from five studies with 422 participants suggested that the effect of low molecular weight heparin on death compared with unfractionated heparin was uncertain, but if anything of small size. There was not enough evidence to prove superiority in reducing recurrence of blood clots or risk of bleeding. The authors found no data to compare the safety profile of these two medications. Also, fondaparinux did not prove or exclude any important effect compared to heparins, on death, blood clots, or bleeding. Similarly, the available evidence did not show any difference between dalteparin and tinzaparin for all tested outcomes.