The American Society of Clinical Oncology (ASCO) recently updated their clinical practice guidelines. The most novel aspect of this update is represented by the introduction of DOACs as pharmacological options both for prophylaxis and treatment of VTE in patients with
cancer. The heterogeneity of the
cancer population in terms of type and stage of the
malignancy, presence of comorbidities, and variability in
cancer treatments and prognosis represent the major challenge of managing VTE in patients with
cancer. The use of VTE prophylaxis is currently recommended in
cancer patients admitted to the hospital for an acute illness or reduced mobility, but no sufficient information is available on the risk of
bleeding during thromboprophylaxis. Concerning the thromboprophylaxis in ambulatory
cancer patients receiving
chemotherapy, further refinement of existing risk models or development of new models are needed for improving risk stratification to identify high-risk
cancer patients. The updated ASCO guidelines recommend the use of DOACs (
edoxaban and
rivaroxaban) for treatment of VTE in patients with
cancer. However, Major concerns on "real-life" use of DOACs in patients with
cancer are highlighted especially for the
bleeding risk in patients with
gastrointestinal cancers and the potential drug-drug interactions with specific anticancer
therapies. CONCLUSIONS: Uncertainties to the updated ASCO guidelines remain concerning a number of indications on prophylaxis and treatment due to the limited evidence available. These limitations determine the low strength of the recommendations. The ongoing studies will contribute to refine the best management of patients with
cancer-associated VTE.