Megace, Avastin and Blood Clots - 1245254

rf1942
Posts:19

My wife Dorothy finished her sixth chemotherapy treatment on Thursday, July 12th for Stage 4 Lung Cancer. She is receiving Carboplatin, Alimta and Avastin and has had a very good response to treatment. Upon admission to the hospital this past February when diagnosed she had blood clots in the right jugular vein, shoulder and right arm, left arm and in both lungs. The clots had resolved upon ultrasound evaluation as recently as June 1st but she had a new clot appear this past Saturday, July 14th in the right jugular vein, shoulder and right arm. She had to be hospitalized for a couple days for Heperin treatment and is now out of the hospital again. After her initial hospitalization in February and March, she was prescribed Megace for loss of appetite and significant weight loss with the chemotherapy. She has taken the Megace since then but her treating pulmonologist on this past Sunday took her off the Megace because of the possibility of it increasing the chances of blood clot development expecially since she also receives Avastin. She is now taking Marinol for appetite and I am wondering if it is likely that the Megace was related to the recent blood clot. Also, she has taken Arixtra (7.5 mg) each day by injection since her hospitalization in February. The pulmonologist has switched her to Lovenox (60 mg, two injections each day) to see if it might be more effective than the Arixtra. Does anyone have any information that will shed some light on this issue since this blood clot was unexpected since she had been doing so well since leaving the hospital in March and with her response to the six chemotherapy treatments. Thank you.

Roland Fleck

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Reply # - July 16, 2012, 11:56 PM

peterz54
Posts: 12

Megace was identified as the likely cause when my wife a developed a large clot in her leg resulting in a week in the hospital not long after starting chemo. she had a very poor appetite from day one, and needed help, so megace was prescribed. she was switched to marinol which she did not take long as it made her ming foggy and she felt paranoid. If memory serves, the literature indicates that clotting can occur in some patients. she has been on coumadin ever since and as of recently has had pains return in her leg. My understanding is that the larger clots may never resolve completely

Reply # - July 17, 2012, 12:10 AM

rf1942
Posts: 19

Thank you for sharing your wife's experience. I am frustrated that our oncologist never mentioned the risk that goes with Megace if in fact it is a problem especially with Avastin. I hope your wife has no more clots and the pain in her legs resolves. I think it is true that clots never fully resolve but the body absorbs most of the clot ultimately if no other problems occur.

Roland

Reply # - July 17, 2012, 10:23 AM

catdander
Posts:

Hi Roland, I think you have a good understanding of the likely culprits of your wife's blood clots. The only one I can think of that you didn't mention is that cancer itself is a culprit. I don't think you can tease apart what the cause was except that deleting some of the causes will likely delete some of the possibility of it happening again and of course the lovenox she is taking is standard in her case.

If it were me from now on I'd ask the onc, pharmacist, and nurses involved about side effects when taking a new drug. It's all such a balancing act.

I hope any pain she is having from the clots resolves soon.

And a BIG Congratulations on the response to chemo.

I'm going to move this to the Cancer Treatment in Treatment related side effects forum folder.

In our new and improved process we ask that you always request notification of comments of your threads so you can find them after we move them. The address doesn't change.

Janine

Reply # - July 17, 2012, 06:23 PM

Dr West
Posts: 4735

Megace (megestrol acetate) can definitely lead to an increased risk of blood clots, but people with cancer, particularly an adenocarcinoma, are at increased risk of blood clots even without being on Megace. Avastin (bevacizumab) is associated with a rather modest (statistically nonsignificant) increase in both bleeding and clotting risks, and I think many people might discontinue it in someone who is having ongoing clotting issues.

I don't think there is a known significant interaction between Megace and Avastin, but it's possible that both given together would be associated with a significantly greater risk of blood clots than either alone (each being associated with a modestly elevated risk).

I don't believe that there are any significant data to say that Lovenox (enoxaparin) is significantly superior to Arixtra (fondiparinux). These drugs are quite similar in efficacy.

-Dr. West

Reply # - July 17, 2012, 07:01 PM

dr walko
Posts: 102

Great question about Megace and Avastin! I completely agree with Dr. West about the possibility of increased blood clot risk from the combination of factors (Megace, Avastin, cancer, etc.) I agree with discontinuing it and going the Marinol route.

Regarding Arixtra vs. Lovenox, I also agree with Dr. West that in clinical trials they have shown equivalence. My one thought would be whether the correct dose of Arixtra was used. Based on the dosing of Lovenox at 60 mg twice daily, I would assume your wife weighs about 60 kg. This would mean the treatment dose of Arixtra should be 7.5 mg once daily. If a lower dose was used, that could explain the blood clot on the drug.

Best wishes with the lovenox!
Dr. Walko

Reply # - July 17, 2012, 08:34 PM

rf1942
Posts: 19

Thank you Janine, Dr. West and Dr. Walko for your input about Megace, Avastin and blood clots as well as the comments on Arixtra vs. Lovenox. My wife was on a 7.5 dose of Arixtra. I am wondering if there is any logic to the idea that taking Lovenox twice a day keeps the levels of the drug a little more stable throughout the day than one dose of Arixtra each morning. We have definitely discontinued the Megace. Any further thoughts would be appreciated.

Roland

Reply # - July 17, 2012, 09:20 PM

Dr West
Posts: 4735

No, different drugs just have different distribution times and patterns of metabolism, and there are many instances where a once daily drug is completely comparable in activity to a twice daily drug...

-Dr. West

Reply # - July 17, 2012, 10:42 PM

rf1942
Posts: 19

Thank you Dr. West for this information. I assume there is still a possibility that different people respond differently to Arixtra and Lovenox with one being more effective than the other? Thank you.

Roland

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