A Review of Apixaban for the Treatment of Cancer-Associated Venous Thromboembolism

Abstract

Venous thromboembolism (VTE) is a common complication of cancer, and its incidence continues to increase. Common anticoagulation treatments for cancer-associated VTE available worldwide include unfractionated heparins, vitamin K antagonists, low-molecular-weight heparins (LMWHs), and direct oral anticoagulants (DOACs). In Japan, while LMWHs are not approved for treating cancer-associated VTE, DOACs have gained traction, and growing evidence suggests that DOACs are effective and safe for the treatment of cancer-associated VTE. Moreover, DOACs have the added advantage of easy oral administration, circumventing the common challenges of subcutaneous administration and repeated monitoring associated with other treatments. Apixaban, a selective factor Xa inhibitor, is a DOAC with a demonstrated efficacy and safety profile in patients treated for cancer-associated VTE, worldwide and in Japan. In this review, we present evidence supporting the efficacy and safety of apixaban for the treatment of VTE and cancer-associated VTE based on three pivotal trials: AMPLIFY, AMPLIFY-J, and CARAVAGGIO. We also review the results of several post hoc subgroup analyses of the data from these trials and real-world evidence demonstrating the safety and effectiveness of apixaban for the treatment of cancer-associated VTE both globally and in Japan.