Programme 29 : Thrombosis and cancer

Programme 29 : Thrombosis and cancer

PROGRAM LEADERS

Pr Nadine AJZENBERG is Head of the Hematology Laboratory of Bichat Hospital and of the Hematology Department of Bichat, Beaujon and Louis-Mourier Hospitals and member of INSERM Unit 1148. The laboratory has expertise in the biological exploration of pro-thrombotic pathologies, particularly in cancer, in close collaboration with INSERM unit 1148.

Pr Isabelle MAHE, Head of Internal Medicine Department, Louis-Mourier Hospital, APHP. Nord, Université Paris Cité.

  • Inserm UMR_S1140, Innovations Thérapeutiques en Hémostase, Paris, France.
  • Chair of the scientific board of INVOVTE-FCRIN network.
  • Expert in thrombosis associated to cancer, as member of French recommendation working group.
  • PI of the international phase 3 trial APICAT evaluating the treatment duration of cancer-associated thromboses.
Key Number P29 Thrombosis and cancer

STRENGTHS IN THE FOLLOWING AREAS

Cancer Care

It is estimated that up to 20% of patients with cancer may develop VTE at some time in their cancer journey. Cancer-associated VTE can lead to hospitalizations, morbidity, delayed cancer treatment, and mortality. The optimal prevention and management of cancer-associated thrombosis (CAT) is of utmost importance. Patients with cancer have unique challenges and comorbidities that can lead to increased risks and concerns with anticoagulation. Oncological, surgical and anesthesiologist teams from the 6 hospitals from AP-HP. Nord are involved in the specific care of cancer-associated venous thrombosis.

The most complicated cases are discussed in a monthly Multidisciplinary Thrombosis Board (MTB) dedicated to thrombosis, including CAT, with a specific computed sheet to register prospectively and present clinical cases in each hospital. Diagnosis, biological exploration (hemostasis) and therapeutic counseling is given at this MTB, or by direct contact with referent team of each hospital, with a high-level knowledge of the profiles of patients on each site, mostly related to the specificities of cancers managed in this site.

Pr Mahé is an internationally well-known expert in therapeutics of cancer-associated thrombosis while Pr Ajzenberg is an expert of biological exploration of hemostasis diseases and abnormalities. Referent oncologists and specialists (pulmonologists, cardiologists, and internists, hematologists) also participate to this MTB and in the routine care of such patients.

Some large clinical research randomized studies are sponsored by AP-HP. Nord in this field questioning both the length and type anti-thrombotic drugs in cancer patients in link with adverse events and recurrence risk. One emblematic on-going trial is APICAT phase 3 international trial (PI/ Pr Mahé), which tests two levels of apixaban dosing for extended treatment in cancer patient.

The strength of this transversal topic is to beneficiate from all clinical (ICU, ER, Pulmonology, Cardiology), radiological (Nuclear medicine, CT-scan, Echocardiography) and biological (Hemostasis, Genetics and Immunology labs) facilities, in each hospital site, and from a large recruitment of cancer patients (more than 16,000 new patients each year), with all tumor types (specifically those with the highest rate of thrombosis: digestive, H&N, Urologic and lung cancers). Many of such patients beneficiate from surgery resection procedures, prone to favor venous thrombosis, needing a specific involvement in prevention and care by the anesthesiologists and intensivists.

In addition, a specific outpatient clinic for patients with difficulties to equilibrate anticoagulant treatment receiving anticoagulant therapy is located in Lariboisière Hospital « CREATIF », while for patients from Beaujon hospital such a same structure exists “the anticoagulant clinic” managed by hematologists (Dr De Raucourt) for patients with liver vascular disease. Specialists in vascular medicine from Internal Medicine departments in Louis Mourier (Pr Mahé), Bichat (Pr Ajzenberg, Dr Alexandra) and St-Louis hospitals (Dr Gauthier) do assure the specialized counseling for patients taken in charge in various clinical departments. Therapeutic Education programs labelled by regional health agency focusing on anticoagulated patients for any reason, including cancer associated thrombosis; Pr Mahé is head of the patient association “anticoag PASS S2D”.

Research

Basic science:

  • U Inserm 1148,
  • U Inserm 1140

Education

Pr Mahé is university teacher about cancer associated thrombosis for medicine residents (pneumology, internal medicine, cardiology), DIU (Thrombosis and bleeding ; Thrombosis and cancer ; heart and internal medicine), post university teaching.