Survival After Solid Cancers in Antithrombotic Trials

      The impact of antithrombotics on cancer is currently under intense investigation because of the excess of solid cancers in trials after thienopyridines such as TRITON (prasugrel), DAPT (prasugrel and clopidogrel), PAR-1 thrombin antagonist in TRACER (vorapaxar), pyrimidines in PEGASUS (ticagrelor), and in APPRAISE-2 after apixaban. However, whether patient survival after solid cancer (SASC) in antithrombotic trials may be affected is unknown. We matched the 1-year SASC rate in antithrombotic trials reported by Food and Drug Administration with the census averages in Surveillance, Epidemiology, and End Results (SEER) Program by the US National Cancer Institute and World Health Organization (WHO) surveys. The Food and Drug Administration provided the SASC data for 3 trials with similar cancer survival of about 70% for the first year of follow-up in TRITON, APPRAISE-2, and ARISTOTEL. Adjusted cancers in TRITON with SEER (odds ratio 0.92; 95% confidence interval 0.53 to 1.59, p = 0.4351) and WHO (odds ratio 0.99; 95% confidence interval 0.57 to 1.7, p = 1.00) revealed very close if not identical SASC rates in antithrombotic trials compared to epidemiologic census estimates. In conclusion, SASC rates in patients enrolled in antithrombotic trials do not differ from SEER or World Health Organization averages.
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        • Coupland L.A.
        • Parish C.R.
        Platelets, selectins, and the control of tumor metastasis.
        Semin Oncol. 2014; 41: 422-434
        • Falanga A.
        • Russo L.
        • Milesi V.
        The coagulopathy of cancer.
        Curr Opin Hematol. 2014; 21: 423-439
        • Wiviott S.D.
        • Braunwald E.
        • McCabe C.H.
        • Montalescot G.
        • Ruzyllo W.
        • Gottlieb S.
        • Neumann F.J.
        • Ardissino D.
        • De Servi S.
        • Murphy S.A.
        • Riesmeyer J.
        • Weerakkody G.
        • Gibson C.M.
        • Antman E.M.
        • the TRITON-TIMI 38 Investigators
        Prasugrel versus clopidogrel in patients with acute coronary syndromes.
        N Engl J Med. 2007; 357: 2001-2015
      1. Food and Drug Administration. Briefing document, February 3, 2009 Meeting of FDA Cardiovascular and Renal Drugs Advisory Committee on Prasugrel. Available at: Accessed on January 16, 2015.

        • NDA 294-886
        Cross-discipline Team Leader Review on Vorapaxar.
        2014 (Available at:) (Accessed on January 17, 2015)
      2. Apixaban clinical review. The Food and Drug Administration. Available at: Accessed on January 17, 2015.

        • Mauri L.
        • Kereiakes D.J.
        • Yeh R.W.
        • Driscoll-Shempp P.
        • Cutlip D.E.
        • Steg P.G.
        • Normand S.L.
        • Braunwald E.
        • Wiviott S.D.
        • Cohen D.J.
        • Holmes Jr., D.R.
        • Krucoff M.W.
        • Hermiller J.
        • Dauerman H.L.
        • Simon D.I.
        • Kandzari D.E.
        • Garratt K.N.
        • Lee D.P.
        • Pow T.K.
        • Ver Lee P.
        • Rinaldi M.J.
        • Massaro J.M.
        • DAPT Study Investigators
        Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents.
        N Engl J Med. 2014; 371: 2155-2166
      3. Malmborg MW, Christiansen C, Gislason G, Schou M. High risk of cancer among survivors of myocardial infarction: A Nationwide Study. Poster 1104/053; ACC 015, San Diego, CA, USA.

        • Bonaca M.P.
        • Bhatt D.L.
        • Cohen M.
        • Steg P.G.
        • Storey R.F.
        • Jensen E.C.
        • Magnani G.
        • Bansilal S.
        • Fish M.P.
        • Im K.
        • Bengtsson O.
        • Ophuis T.O.
        • Budaj A.
        • Theroux P.
        • Ruda M.
        • Hamm C.
        • Goto S.
        • Spinar J.
        • Nicolau J.C.
        • Kiss R.G.
        • Murphy S.A.
        • Wiviott S.D.
        • Held P.
        • Braunwald E.
        • Sabatine M.S.
        • PEGASUS-TIMI 54 Steering Committee and Investigators
        Long-term use of ticagrelor in patients with prior myocardial infarction.
        N Engl J Med. 2015; 372: 1791-1800
        • Serebruany V.L.
        • Dinicolantonio J.J.
        • Can M.M.
        • Goto S.
        Unclassified pleomorphic and spindle cell pulmonary neoplasm with brain metastases after prasugrel.
        Cardiology. 2013; 124: 85-90
      4. Surveillance, Epidemiology, and End Results (SEER) Program Populations (1969-2012) (Available at:, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, accessed on February 27, 2015.

        • Mathers C.D.
        • Boschi-Pinto C.
        • Lopez A.D.
        • Murray C.J.L.
        Cancer incidence, mortality and survival by site for 14 regions of the world.
        in: Global Programme on Evidence for Health Policy Discussion Paper No. 13. World Health Organization, Geneva, Switzerland2001 (Accessed on March 26, 2015)