In patients with cancer receiving anticoagulation therapy, circulating tissue factor may represent a potential biomarker of recurrent venous thromboembolism (VTE), according to a study published in the Journal of Clinical Oncology.1
Although circulating tissue factor has been evaluated as a biomarker for predicting initial VTE in cancer, it has not been studied as a predictor for recurrent VTE. Therefore, researchers sought to evaluate the association of tissue factor, clinical risk factors, and other biomarkers measured at the time of initial VTE with recurrent VTE.
In this prespecified analysis of the multicenter, randomized CATCH (Comparison of Acute Treatments in Cancer Hemostasis; ClinicalTrials.gov Identifier: NCT01130025) trial, researchers assayed circulating tissue factor ELISA, soluble P-selectin, D-dimer, FVIII, and C-reactive protein of patients with cancer acute, symptomatic VTE receiving tinzaparin once daily or dose-adjusted warfarin for 6 months.
Among the 900 patients included in this analysis, 8.4% experienced a recurrent VTE. Mean and median circulating tissue factor levels were 72.5 pg/mL and 50.3 pg/mL, respectively.
Results showed that patients in the highest quartile of tissue factor levels (greater than 64.6 pg/mL) had more than a 3 times higher risk for developing VTE recurrence compared with all other patients (relative risk [RR], 3.3; 95% CI, 2.1-5.1; P <.001).
In a competing risk regression analysis of time to recurrent VTE, researchers found that tissue factor continued to be strongly associated with recurrent VTE (subdistribution hazard ratio [SHR], 3.3; 95% CI, 1.7-6.4).
The analysis further revealed that venous compression from mass (SHR, 3.1; 95% CI, 1.4-6.5) and hepatobiliary cancer (SHR, 5.5; 95% CI, 2.3-13.6) were significantly associated with VTE recurrence.
These findings suggest that researchers may be able to incorporate circulating tissue factor levels into a risk-adapted strategy to better identify high-risk patients who may derive more benefit from intensive anticoagulation approaches.
1. Khorana AA, Kamphuisen PW, Meyer G, et al. Tissue factor as a predictor of recurrent venous thromboembolism in malignancy: Biomarker analyses of the CATCH trial. J Clin Oncol. 2016 Dec 28. doi: 10.1200/JCO.2016.67.4564. [Epub ahead of print]