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Low-molecular-weight heparin does not improve cancer survival

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Contrary to previous findings, patients with advanced cancer do not have significantly improved survival when they are treated with a low-molecular-weight heparin, European investigators report in the Journal of Clinical Oncology online April 18.

Cancer is often associated with activation of the hemostatic system, the authors note, and previous studies have shown a significant survival benefit for cancer patients treated with low-molecular-weight heparin (LMWH).

While those results “were intriguing,” the heterogeneity of the patient populations and variation in LMWH regimens left some issues unresolved, Dr. Frederiek F. van Doormaal, with the Academic Medical Center in Amsterdam, the Netherlands, and colleagues explain.

They therefore designed a trial of the LMWH nadroparin in three different cancer types expected to have a comparable prognosis — hormone-refractory prostate cancer, non-small-cell lung cancer IIIB, and locally advanced pancreatic cancer. A total of 244 patients were allocated to nadroparin, and 259 were allocated to no nadroparin, for 6 weeks along with their standard anticancer treatment.

After the initial 6 weeks, patients in the nadroparin group were eligible for repeated 2-week cycles of nadroparin separated by 4-week washout periods, for a maximum of six cycles.

Median survival was not significantly different in the two arms, at 13.1 months in the nadroparin recipients and 11.9 months in the control group (HR, 0.94), the researchers report. Furthermore, “No difference in time to progression was observed.”

Major bleeding occurred in 10 patients (4.1%) treated with nadroparin compared with 9 patients (3.5%) in the control group — not a significant difference, Dr. van Doormaal and colleagues found.

“In summary,” they write, “this study did not show a statistically significant nor clinically relevant survival effect of nadroparin in patients with advanced prostate, lung, and pancreatic cancer.”

However, they add, “Given the other ongoing studies in this area, as well as the previous data, we have to wait for the new evidence before the role of LMWH in cancer survival can be definitely defined.”


Randomized Trial of the Effect of the Low Molecular Weight Heparin Nadroparin on Survival in Patients With Cancer

J Clin Oncol 2011;29.