Synergistic effects of anticoagulants and platelet aggregation inhibitors with immune checkpoint inhibitors in cancer therapy: a comprehensive review of preclinical and clinical evidence.

[BACKGROUND] The rapidly advancing field of cancer therapy has sparked growing interest in the potential synergy between anticoagulation and immune checkpoint inhibitor (ICI) therapy. Recent research highlights that anticoagulants, traditionally used for thromboprophylaxis and managing thromboembolic events, may also exhibit immunomodulatory properties. These properties can influence the tumor microenvironment by promoting immune cell infiltration, enhancing antitumor immune responses, and potentially reducing metastasis. This emerging evidence underscores the complex interplay between coagulation pathways and immune regulation, paving the way for further exploration of the clinical benefits of combining anticoagulation with ICI therapy.

[METHODS] A systematic review was conducted to synthesize the current evidence on the interplay between anticoagulation and ICI. Relevant studies examining their mechanisms of action, clinical outcomes, and potential interactions were identified and analyzed. Comprehensive database searches were performed to ensure a thorough and inclusive review of the literature.

[RESULTS] Preclinical studies consistently show that combining ICIs with anticoagulants can enhance cancer treatment by inhibiting tumor growth and metastasis. In particular, low molecular weight heparin, oral factor Xa (FXa) inhibitors, and platelet inhibitors have demonstrated synergistic effects with ICI. However, these findings have not been consistently replicated in clinical settings. While two retrospective studies reported no significant impact of anticoagulants on ICI efficacy, one retrospective study found improved outcomes in advanced melanoma patients treated with ICI and FXa inhibitors. Additionally, another retrospective study revealed a significant association between platelet aggregation inhibition and extended progression-free survival.

[CONCLUSIONS] Our literature review underscores the intricate relationship between anticoagulation and ICIs in cancer therapy. Future studies should prioritize exploring the interactions between ICI, FXa inhibitors, and antiplatelet agents.