Preface to the Proceedings of the 10^th International Conference on Thrombosis and Hemostasis Issues in Cancer, 2020

Dear Colleagues,

We are pleased to present this volume of the Proceedings of the 10^th International Conference on Thrombosis and Hemostasis Issues in Cancer (ICTHIC) that was scheduled to be held in Bergamo, Italy April 17–19, 2020. This represents a landmark year for both the ICTHIC meeting – our tenth anniversary! – and for the growing field of cancer-associated thrombosis. The ICTHIC meeting holds a special place in the hearts and minds of researchers focusing on this very interdisciplinary field. It is a unique conference bringing together epidemiologists, clinical trialists, practicing physicians, basic scientists and translational researchers from disciplines as varied as pulmonology, hematology, oncology and supportive/palliative care, all focused on the same important clinical problem. Some of us have “grown up” attending the ICTHIC conference over the past two decades – starting as trainees and junior faculty and moving on to leadership positions in various disciplines. The overarching theme of ICTHIC has been to integrate these varied perspectives into the ultimate goal of reducing the burden and consequences of cancer-associated thrombosis, and to foster the careers of young investigators in the field so they can carry the torch forward. Since the last meeting in 2018, we are excited to see remarkable developments in the field that are rapidly being translated into findings meaningful for cancer patients. The plan for this year’s ICTHIC meeting was to reflect this paradigm shift in our scientific understanding as well as in the treatment and prevention of VTE in malignancy. Unfortunately, due to the COVID-19 pandemic that has gripped most countries worldwide and especially hit Italy hard, we were unable to have an in-person meeting. In the spirit of continued scientific discussions, however, we are pleased to provide in this supplement educational articles based on the planned schedule of the meeting.

Our opening set of articles focuses on new insights in the prevalence of cancer-associated thrombosis. Luis Jara-Palomares from Spain describes current landscape regarding screening for occult malignancy in patients presenting with unprovoked VTE. Although the association of VTE with cancer is over a century old, new anti-cancer medications continue to be associated with this complication. Marcel Levi from the Netherlands presents an overview of thrombotic complications of novel anticancer agents. Arterial thromboembolic events are increasingly understood to be more prevalent in cancer as well. Finally, emerging data regarding the impact of thrombosis in pediatric cancers is reviewed by Gili Kenet from Israel.

Our second set of articles focuses on the rapidly evolving field of biomarkers predictive of cancer-associated thrombosis. Standardization of biospecimen collection and analysis is exceedingly important as this field develops, and Agnes Lee from Canada describes results of a major recent study evaluating the impact of preclinical variables on thrombotic biomarkers levels in cancer. Nigel Key from the United States describes his group’s efforts regarding biomarker development utilizing specimens from the AVERT trial of thromboprophylaxis. Marina Marchetti from Italy provides an update on the role of thrombotic biomarkers in occult cancer and cancer risk prediction. Henri Versteeg from the Netherlands describes new findings of specific genes and proteins associated with risk of cancer-associated thrombosis. A round table introduced by Grigoris Gerotziafas from France provides an overview of risk assessment models for VTE in cancer.

Our third themed set focuses on the somewhat neglected area of hematologic malignancies and their association with VTE. Benjamin Brenner from Israel provides a review of risk assessment of thrombosis and bleeding in hematological malignancies. Miguel Sanz from Spain describes recent advances in management of coagulopathy in acute promyelocytic leukemia. Avi Leader from Israel describes pitfalls and benefits of anticoagulant and antiplatelet treatments in cancer patients with thrombocytopenia, about which little is known. Finally, Kristen Sanfilippo from the United States describes her group’s leadership regarding risk prediction of VTE in patients with multiple myeloma.

As always, a major highlight of the ICTHIC meeting is the Simon Karpatkin Memorial Lecture, honoring the memory of the late Professor Karpatkin of New York University. This year’s awardee is Professor Ingrid Pabinger who has long been involved in pioneering work related to our understanding of the epidemiology and pathophysiology of cancer-associated VTE. Her foresight in establishing a long-running prospective cohort study of cancer patients with the Vienna Cancer and Thrombosis Study Group, including obtaining biospecimens from patients who joined the cohort, has been foundational to the emerging field of risk prediction and to biomarker development in this setting. She discusses her decades-long research effort in an overview of the topic “Prediction of VTE in Cancer: Past, Present and Future”.

The exciting new clinical findings in the field are being translated into updated guidelines from various major societies. Gary Lyman from the United States provides an overview of VTE treatment and prevention guidelines. Our next theme is focused on prevention of VTE in cancer patients. Inpatient thromboprophylaxis remains an important knowledge gap in the field, with minimal randomized trials evidence in patients with cancer as highlighted by Jeffrey Zwicker sfrom the United States. Anthony Maraveyas from the United Kingdom describes roles of LMWH for prevention in cancer patients including in the medically ill and post-operative settings.

Authors in the next set of articles focus on new basic and translational insights into hemostasis and cancer. Janusz Rak from Canada describes his group’s elegant ongoing work regarding the genetic and epigenetic regulators of single cell coagulomes in brain tumors. Wolfram Ruf from Germany evaluates coagulation signaling related to cancer immunotherapy. Christophe Dubois from France describes mouse models of thrombosis and cancer. Finally, Joe Palumbo from the United States describes the impact of thrombin and fibrin-driven inflammation in cancer development

The final set of articles evaluates changing paradigms in treatment of cancer-associated VTE. Giancarlo Agnelli from Italy who has led many practice-changing randomized trials in the field provides his view on how treatment findings from clinical trials translate into real-world practice. Finally, Simon Noble from the United Kingdom brings his program’s unique insights on the importance of VTE in palliative care patients.

We thank all the authors for their contributions to this volume. We believe strongly that – now more than ever – conferences such as ICTHIC have the potential to play a vital role in the advancement of science and in translating its benefit to patients as well as in providing formal and informal networks for young trainees and future leaders in the field. On our tenth anniversary – completing a time span of two decades – we hope you will celebrate with us the efforts of the ICTHIC meeting toward the advancement of basic, translational and clinical aspects of cancer-associated thrombosis.