Rivaroxaban for Cancer-related Blood Clot Prevention

(TRIM-Line Trial)

Recruiting at 11 trial locations

Overseen By Bashour Yazji

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: Ottawa Hospital Research Institute

Must not be taking: Dual antiplatelets, CYP 3A4 inhibitors

Disqualifiers: Pregnancy, Renal insufficiency, Liver disease, others

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 90 days

1828 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how well rivaroxaban (also known as Xarelto) prevents blood clots in cancer patients with a central venous catheter (a tube placed in a large vein for treatment). Researchers aim to determine if rivaroxaban is both effective and safe for this purpose. The trial includes two groups: one receiving rivaroxaban and the other receiving a placebo (a pill with no active drug). It may suit cancer patients who have had a central venous catheter inserted within the last three days. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants a chance to contribute to potentially groundbreaking treatment advancements.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are on certain strong medications like cobicistat or ketoconazole, or if you need dual antiplatelet therapy.

Is there any evidence suggesting that rivaroxaban is likely to be safe for humans?

Research has shown that rivaroxaban is generally safe for people with cancer. One study found that serious side effects occurred in 5.4% of patients taking rivaroxaban, compared to 1.7% of those using enoxaparin or a placebo. Another study found that rivaroxaban was as safe as apixaban, another blood thinner, over six months. These results suggest that while some risks exist, rivaroxaban is mostly safe for preventing blood clots in cancer patients. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising?

Rivaroxaban is unique because it's a direct oral anticoagulant (DOAC) that specifically targets a protein called Factor Xa, which plays a crucial role in blood clot formation. Unlike traditional options like warfarin, which require frequent blood monitoring and dietary restrictions, rivaroxaban offers a simpler, once-daily dosing without the need for regular lab tests. Researchers are excited about rivaroxaban for cancer-related blood clot prevention because it could provide a more convenient and effective way to reduce the risk of dangerous clots in cancer patients, who are particularly vulnerable to these complications.

What evidence suggests that rivaroxaban might be an effective treatment for cancer-related blood clot prevention?

Research shows that rivaroxaban, which participants in this trial may receive, effectively treats blood clots in cancer patients. One study found that rivaroxaban reduced the risk of recurring blood clots by 31% compared to low molecular-weight heparin, a common blood thinner. Another study found that rivaroxaban performed as well as other blood thinners like apixaban in managing cancer-related blood clots. These results suggest it could help prevent blood clots in cancer patients with central venous catheters (CVC). However, some studies did not find a significantly lower rate of blood clots with rivaroxaban in high-risk cancer patients, so results can vary. Participants in this trial will receive either rivaroxaban or a placebo through randomization. ^{2 3 5 6 7}

Who Is on the Research Team?

Marc Carrier, MD

Principal Investigator

Ottawa Hospital Research Institute

Are You a Good Fit for This Trial?

This trial is for adults over 18 with any type of cancer who have had a central venous catheter (CVC) placed in the last 72 hours. It's not suitable for those with severe liver disease, low platelets, CVC older than 72 hours, other anticoagulation needs, recent major bleeding, pregnancy plans within three months, certain skin cancers only, life expectancy under three months or known allergies to rivaroxaban.

Inclusion Criteria

I am 18 or older with cancer and had a central venous catheter placed within the last 3 days.

Exclusion Criteria

Your platelet count has been very low in the past 3 months.

You are allergic to rivaroxaban.

You are not expected to live for more than 3 months.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either rivaroxaban 10mg daily or placebo for the prevention of VTE

90 days

Regular visits for monitoring and assessment

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Rivaroxaban

Trial Overview

The trial tests if a blood thinner called Rivaroxaban can prevent blood clots in cancer patients who have a CVC. The goal is to see how effective and safe this medication is at stopping clots from forming without causing too many side effects.

How Is the Trial Designed?

Group I: Experimental Experimental Treatment 1 Intervention

Rivaroxaban 10mg OD

Group II: Control Placebo Group 1 Intervention

Identical Placebo 10mg OD

Rivaroxaban is already approved in United States, European Union for the following indications:

Approved in United States as Xarelto for:

• Deep vein thrombosis (DVT)
• Venous thromboembolism (VTE)
• Stroke prevention in non-valvular atrial fibrillation
• Prevention of VTE in patients undergoing knee or hip replacement surgery

Approved in European Union as Xarelto for:

• Deep vein thrombosis (DVT)
• Venous thromboembolism (VTE)
• Stroke prevention in non-valvular atrial fibrillation
• Prevention of VTE in patients undergoing knee or hip replacement surgery
• Prevention of atherothrombotic events in patients with acute coronary syndrome

Who Is Running the Clinical Trial?

Ottawa Hospital Research Institute

Lead Sponsor

Trials

585

Recruited

3,283,000+

Published Research Related to This Trial

In a study of 400 patients with active cancer and venous thromboembolism, rivaroxaban demonstrated a low recurrence rate of 3.25% for symptomatic VTE, indicating its efficacy as an anticoagulant in this population.

The safety profile of rivaroxaban was acceptable, with major bleeding incidents occurring in 5.5% of patients during treatment, suggesting it can be a viable option for managing cancer-associated thrombosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oral Rivaroxaban for the Treatment of Symptomatic Venous Thromboembolism in 400 Patients With Active Cancer: A Single-Center Experience. Pignataro, BS., Nishinari, K., Cavalcante, RN., et al.[2018]

Rivaroxaban, a direct Factor Xa inhibitor, has been evaluated in over 24,000 patients across Phase II and III trials for its safety and efficacy in preventing and treating venous thromboembolism, showing promise as an alternative to traditional vitamin K antagonists like warfarin.

The drug is also being studied for various conditions, including pulmonary embolism and stroke prevention in patients with non-valvular atrial fibrillation, indicating its potential broad application in thrombosis management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rivaroxaban, an oral direct factor Xa inhibitor. Piccini, JP., Patel, MR., Mahaffey, KW., et al.[2019]

Rivaroxaban is a direct factor Xa inhibitor that offers a simplified alternative to traditional vitamin K antagonists like warfarin, allowing for once-daily dosing without the need for frequent monitoring or dose adjustments.

In phase-II and phase-III trials involving over 24,000 patients, rivaroxaban has demonstrated safety and efficacy for preventing and treating venous thromboembolism, and is also being studied for other conditions like pulmonary embolism and stroke prevention in atrial fibrillation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oral direct factor Xa inhibitors, with special emphasis on rivaroxaban. Mousa, SA.[2015]

In a study of 144 adult patients with solid tumor malignancies receiving rivaroxaban, 44% experienced bleeding incidents, indicating a significant risk associated with this anticoagulant therapy.

Specific cancer types, including bladder, breast, melanoma, pancreas, prostate, and renal cell cancers, showed higher incidences of both major and minor bleeding, suggesting that these patients may require closer monitoring while on rivaroxaban.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of bleeding incidences associated with rivaroxaban therapy in adults with solid tumors. Weddle, KJ., Kiel, PJ., Patel, PJ.[2019]

In a study of 193 patients with venous thromboembolism (VTE) and active cancer, rivaroxaban demonstrated acceptable effectiveness, with similar rates of VTE recurrence and major bleeding compared to 823 patients without active cancer.

However, patients with active cancer had a significantly higher all-cause mortality rate (23.29% vs. 2.03% per patient-year), indicating that while rivaroxaban is effective, the underlying cancer poses a greater risk to patient survival.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness and safety of rivaroxaban in patients with venous thromboembolism and active cancer: A subanalysis of the J'xactly study. Hisatake, S., Ikeda, T., Fukuda, I., et al.[2023]

Rivaroxaban is an effective oral medication that inhibits Factor Xa, showing significant efficacy in preventing and treating thromboembolic disorders, including venous thromboembolism after major orthopedic surgery.

In phase III studies, rivaroxaban was found to be more effective than enoxaparin for preventing blood clots after knee surgery, with a similar low risk of bleeding, making it a promising alternative to existing treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rivaroxaban. A novel, oral, direct factor Xa inhibitor in clinical development for the prevention and treatment of thromboembolic disorders. Perzborn, E., Kubitza, D., Misselwitz, F.[2015]

In a study of 296 patients treated with rivaroxaban for venous thromboembolism, those with active malignancy had similar rates of recurrence (3.3%) compared to those without cancer (2.8%), indicating that rivaroxaban is effective in both groups.

While rivaroxaban showed comparable safety profiles, there were borderline higher rates of major and nonmajor clinically relevant bleeding in patients with cancer, suggesting a need for careful monitoring in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of Rivaroxaban in Patients with Venous Thromboembolism and Active Malignancy: A Single-Center Registry. Bott-Kitslaar, DM., Saadiq, RA., McBane, RD., et al.[2022]

Rivaroxaban is a direct factor Xa inhibitor that is effective in preventing venous thromboembolism in patients undergoing elective knee or hip replacement surgery, with a recommended dose of 10 mg per day.

In patients with non-valvular atrial fibrillation, rivaroxaban (20 mg per day) is approved for stroke prevention, and its low dose (2.5 mg twice daily) has shown promise in reducing cardiovascular events in those with recent acute coronary syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Rivaroxaban in the prevention and treatment of thromboembolic disorders]. Helbing, T., Bode, C., Moser, M.[2015]

This study is investigating the effects of Rivaroxaban, a direct oral anticoagulant, on early breast cancer patients, specifically looking at its potential to inhibit tumor growth and progression in estrogen receptor-negative cases, which are known to have a poorer prognosis.

Eighty-eight treatment-naïve early breast cancer patients will be randomized to receive Rivaroxaban or no treatment for 11 to 17 days before surgery, with the primary goal of measuring changes in tumor proliferation (Ki67) and secondary outcomes related to cancer progression and coagulation markers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rivaroxaban compared to no treatment in ER-negative stage I-III early breast cancer patients (the TIP Trial): study protocol for a phase II preoperative window-of-opportunity study design randomised controlled trial. Castle, J., Blower, E., Bundred, NJ., et al.[2021]

In a study of 127 oncology patients with venous thromboembolism, oral factor Xa inhibitors (rivaroxaban/apixaban) showed no significant difference in recurrence rates compared to warfarin and enoxaparin after three months, indicating their potential effectiveness in this population.

The study also found that major bleeding was rare, occurring in only one patient on enoxaparin, and mortality rates were lowest in the oral factor Xa inhibitor group, suggesting a favorable safety profile, but further randomized trials are necessary to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Retrospective comparison of low molecular weight heparin vs. warfarin vs. oral Xa inhibitors for the prevention of recurrent venous thromboembolism in oncology patients: The Re-CLOT study. Alzghari, SK., Seago, SE., Garza, JE., et al.[2018]

Direct oral anticoagulants, particularly rivaroxaban, have been shown to be as effective and safe as traditional vitamin K antagonists for treating and preventing thrombosis in cancer patients, based on recent randomized clinical trials.

Rivaroxaban is now considered a viable alternative to low-molecular-weight heparins for managing cancer-associated venous thromboembolic complications, as supported by significant clinical evidence and guidelines from the International Society on Thrombosis and Hemostasis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Venous thromboembolic complications in oncological patients: present-day possibilities of effective and safe anticoagulant therapy]. Fokin, AA., Bagaev, KV.[2020]

Citations

1.

jnj.com

jnj.com/media-center/press-releases/real-world-study-confirms-benefit-of-xarelto-rivaroxaban-for-secondary-prevention-of-venous-thromboembolism-in-cancer-patients

Real-World Study Confirms Benefit of XARELTO® ...

Head-to-head observational analysis showed XARELTO® as effective in treating cancer-associated thromboembolism (CAT) as apixaban.

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10454885/

Rivaroxaban for cancer-associated venous thromboembolism

Conclusions. In a selected study population of cancer patients with VTE, rivaroxaban is as good as other anticoagulants, even though there was heterogeneity in ...

3.

jacc.org

jacc.org/doi/10.1016/j.jaccao.2022.10.014

Effectiveness and Safety of Rivaroxaban and Low ...

Rivaroxaban was associated with a 31% reduced risk of recurrent venous thromboembolism (VTE) vs low molecular-weight heparin (LMWH) (HR: 0.69; 95% CI: 0.51-0.92) ...

4.

nejm.org

nejm.org/doi/full/10.1056/NEJMoa1814630

Rivaroxaban for Thromboprophylaxis in High-Risk ...

In high-risk ambulatory patients with cancer, treatment with rivaroxaban did not result in a significantly lower incidence of venous ...

5.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10332896/

Rivaroxaban versus Apixaban for Treatment of Cancer ...

Rivaroxaban and apixaban have similar effectiveness and safety for treatment of cancer-associated VTE through 6 months. · Clinicians should ...

6.

ahajournals.org

ahajournals.org/doi/10.1161/circ.150.suppl_1.4143604

Abstract 4143604: Efficacy and Safety of Rivaroxaban ...

Conclusion: While rivaroxaban is associated with low adverse outcomes suggesting its use in treating VTE in cancer patients, further research is ...

7.

jnjmedicalconnect.com

jnjmedicalconnect.com/products/xarelto/medical-content/use-of-xarelto-in-adults-with-cancer-associated-thrombosis

Use of XARELTO in Adults with Cancer-Associated ...

The primary safety outcome occurred in 5.4% of XARELTO-treated patients with active cancer and in 1.7% of enoxaparin/placebo-treated patients ...