© 2006 European Society for Medical Oncology
letters to the editor |
Does low-molecular-weight heparin influence cancer-related mortality?
I read with interest the meta-analysis by Feretti et al. [1] on the effect of low-molecular-weight heparin (LMWH) on cancer-related mortality. The authors did not find any significant difference for cancer-related mortality between LMWH and oral anticoagulants. Although they include eight studies in their analysis, most of the patients were included in two studies [2, 3]. In both studies, most of the patients had metastatic cancer and, in fact, no difference was observed in either global or cancer-related mortality rates. On the other hand, as Ferretti et al. point out, the study reported by Lee et al. [4] showed that the difference in the global mortality associated with LMWH was observed only in patients with localized disease, and not in those with metastatic disease. This result is in line with several other studies evaluating LMWH in cancer patients suggesting that the beneficial effect of LMWH on mortality was restricted to or predominant in patients with localized disease [5–7]. These observations are supported by experimental data, suggesting that LMWH acts primarily on the metastatic process rather than cancer cell proliferation. Several large clinical trials are under way in various tumor types in order to confirm these findings.
Service de Pneumologie, soins intensifs, Hôpital Europeén Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France
* (E-mail: guy.meyer{at}hop.egp.ap-hop-paris.fr)
References
1. Ferretti G, Bria E, Giannarelli D, et al. (2006) Does low-molecular-weight heparin influence cancer-related mortality? Ann Oncol 17:1604–1606.
2. Lee AY, Levine MN, Baker RI, et al. (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:2146–153.
3. Meyer G, Marjanovic Z, Valke J, et al. (2002) Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 162:151729–1735.
4. Lee AY, Rickles FR, Julian JA, et al. (2005) Randomized comparison of low molecular weight heparin and coumarin derivatives on the survival of patients with cancer and venous-thromboembolism. J Clin Oncol 23:102123–2129.
5. Klerk CP, Smorenburg SM, Otten HM, et al. (2005) The effect of low molecular weight heparin on survival patients with advanced malignancy. J Clin Oncol 23:102119–2120.
6. Kakkar AK, Levine MN, Kadziola Z, et al. (2004) Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the fragmin advanced malignancy outcome study (FAMOUS). J Clin Oncol 22:101944–1948.
7. Altinbas M, Coskun HS, Er O, et al. (2004) A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer. J Thromb Haemost 2:81266–1271.[CrossRef][ISI][Medline]
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