sP-selectin and D-dimer used to predict VTE risk in cancer patients

Cancer patients have a higher risk for VTE, but should they all receive anticoagulation therapy? When is pharmacological prophylaxis warranted?  A recent published paper seems to suggest that sP-selectin and D-dimer may be used to help predict VTE risk in cancer patients.

Here's the abstract:

The risk of venous thromboembolism (VTE) is increased in cancer patients. To improve prediction of VTE in cancer patients, we performed a prospective and observational cohort study of patients with newly diagnosed cancer or progression javascript:void(0)of disease after remission. A previously developed risk scoring model for prediction of VTE that included clinical (tumour entity and body-mass-index) and laboratory (hemoglobin level, thrombocyte- and leucocyte-count) parameters was expanded by incorporating two biomarkers, soluble P-selectin and D-dimer. Of 819 patients 61 (7.4%) experienced VTE during a median follow-up of 656 days. The cumulative VTE probability in the original risk model after 6 months was 17.7% in patients with the highest risk score (≥3, n=93), 9.6% in those with score 2 (n=221), 3.8% in those with score 1 (n=229) and 1.5% in those with score 0 (n=276). In the expanded risk model, the cumulative VTE probability after 6 months in patients with the highest score (≥5, n=30) was 35.0% and 10.3% in those with an intermediate score (score 3, n=130) as opposed to only 1.0% in patients with score 0 (n=200); the hazard ratio of patients with the highest compared to those with the lowest score was 25.9 (8.0-84.6). Clinical and standard laboratory parameters with addition of biomarkers enable prediction of VTE and allow identification of cancer patients at high or low risk of VTE.

Ay C, Dunkler D, Marosi C, Chiriac AL, Vormittag R, Simanek R, Quehenberger P, Zielinski C, Pabinger I. Prediction of venous thromboembolism in cancer patients. Blood. 2010 Sep 9.

Click here to read the abstract.

Novel Cancer Biomarkers, Oncogenes, and Targeted Therapies

Since I graduated from medical school (many years ago), we have discovered so many new cancer biomarkers and oncogenes. The world of genomics has really taken off! As I think about the future of medicine, I often wonder about how many more biomarkers and oncogenes we will discover. How many new drugs will get developed to specifically target the overexpression of specific oncogenes? Human genetics and molecular biology are becoming more fascinating topics because we now have the ability to engineer drugs that target specific genes and gene products.

Here are a few examples of some of the newer areas of cancer research:

• DNA Methylation Biomarker, Septin 9, (Colorectal Cancer)
• Non-codingRNA (microRNA)
• Metabolomics-derived Biochemical Markers (Prostate Cancer)

We all know about BRCA1 and BRCA2. We also know that HER2 overexpression can be targeted by an anti-HER2 humanized monoclonal antibody (called trastuzumab or Herceptin). The topic of personalized medicine has been gaining tremendous traction, especially in the oncology world. What if there was a way to prevent hereditary cancers? If we can identify ways to target the specific gene (or genes) that are causing cancer, then we might be able to prevent those malignancies. Advances in drug development have led to many biologic agents (targeted therapies) that act on specific pathways like VEGF (vascular endothelial growth factor) and block the formation of new blood vessels. You've probably heard of bevacizumab or Avastin, which is a VEGF-inhibitor.

Speaking of biologic drugs, I still remember when the first tyrosine kinase inhibitor (TKI) came out. Remember when Gleevec (imatinib) came out? TKIs have now evolved into agents that target multiple different tyrosine kinase pathways and even inhibit EGFR (epidermal growth factor receptor). We now have nilotinib (Tasigna), dasatinib (Sprycel), erlotinib (Tarceva), gefitinib (Iressa), and several more coming. How do medical students keep up with all these drugs? Students today are even learning about new compounds like histone deacetylase inhibitors (HDAC inhibitors or HDIs). We've certainly come a long way in the world of cancer biomarkers, oncogenes, and targeted therapies. What will the future look like as we learn how to target these biomarkers and oncogenes? Image source: