Data from an in vitro model of platelet-tumor cell interaction and from a crossover in patients with metastatic cancer suggest that ticagrelor monotherapy appears to reduce platelet aggregation and activation. The results from the Ticagrelor-Oncology (TICONC) study were published June 16 in JACC: CardioOncology.

In cancer, platelets may facilitate metastatic spread by a number of mechanisms and also contribute to thrombotic complications.

Joy R. Wright, PhD, and colleagues first examined an in vitro model of platelet-tumor cell interaction within the circulation to compare the effects of ticagrelor monotherapy and dual antiplatelet therapy (DAPT) with ticagrelor and aspirin on platelet activation and interaction with human breast cancer and colorectal cancer.

Then they conducted a randomized, crossover study to examine the effects of monotherapy with ticagrelor or aspirin compared with DAPT on platelets in patients with breast cancer (n=10) and colorectal cancer (n=6) compared with healthy controls (n=22). The study completion rate was 81.6%.

Results from the in vitro model showed that ticagrelor monotherapy, but not aspirin, primarily reduced tumor cell-induced platelet aggregation and activation in response to human breast cancer cells (MCF-7) and colorectal cancer cells (HT-29). Furthermore, monotherapy with ticagrelor or aspirin significantly reduced adhesion of colorectal cancer cells, but not breast cancer cells, in the presence of platelets.

Results from the crossover study showed that ticagrelor could significantly reduce spontaneous platelet aggregation in patients with metastatic cancer.

This is the first study to examine the possible benefits of ticagrelor in a cancer population, write the authors and is a limitation of the study because direct comparisons are not possible. The small sample size is another limitation.

"These findings support further investigation of the potential role for ticagrelor monotherapy as prophylaxis in cancer patient populations at high risk for thrombotic complications (e.g., venous thromboembolism)," write the study authors, "as well as long-term assessment of its ability to reduce metastatic spread and improve progression-free survival.

Clinical Topics: Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine

Keywords: Platelet Aggregation, Platelet Aggregation Inhibitors, Aspirin, Blood Platelets, Breast Neoplasms, Venous Thromboembolism, Platelet Activation, Platelet Function Tests, Blood Platelet Disorders

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