Cancer survival: Which low molecular weight heparin (LMWH) is best?

• Published in: Journal of clinical oncology Vol. 25; no. 18_suppl; p. 19624
• Main Authors: Spahr, J. E., Akerley, W., Rodgers, G. M.
• Format: Journal Article
• Language: English
• Published: 20.06.2007
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2007.25.18_suppl.19624

Abstract only 19624 Background: The role of LMWH in cancer survival is controversial. There have been 6 randomized trials specifically evaluating cancer survival with LMWH. The objective of this study was to determine which LMWH is best for cancer survival, based on literature data. Methods: We performed a review of the literature for studies published from 1990 - 2007. Results: We identified 14 studies that included data on cancer survival and the use of LMWH, even if the primary endpoint was not cancer survival. We found studies for 5 LMWH products (See Table ). Conclusions: Based on our analysis, dalteparin is the most well studied LMWH in cancer. The 4 best designed trials looking at cancer survival were performed using dalteparin with over 1190 patients. The magnitude of benefit appears to be greatest in patients with better up-front estimated survival, and absence of metastatic disease. The estimated survival benefit was 25%. The second best studied LMWH appears to be nadroparin, with 5 trials with over 480 patients, including the MALT trial, and the most recently published Icli trial. Unfortunately, nadroparin is currently not available in the US. The studies of the other LMWH lack evidence to draw significant conclusions. The results of this study must be interpreted with caution. As there have been no randomized clinical trials comparing one LMWH against another in cancer survival, the studies we compared were not always similar in design or LMWH dosing, and cannot be compared head-to-head. No significant financial relationships to disclose. [Table: see text]