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VTE During Chemotherapy — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesVTE During ChemotherapySCE Medical Oncology

A 68-year-old man with oesophageal adenocarcinoma is started on perioperative FLOT chemotherapy. After 2 cycles, he develops bilateral pulmonary emboli. What is the recommended approach to continuing chemotherapy?

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Correct answer: B — Continue chemotherapy with therapeutic anticoagulation — VTE is not an absolute contraindication to continuing cancer treatment

VTE during chemotherapy is common (5-15% incidence depending on cancer type). Established VTE is generally not a contraindication to continuing chemotherapy, provided therapeutic anticoagulation is initiated and maintained. LMWH or DOACs are used per cancer-associated VTE guidelines. Chemotherapy doses may need modification if there is haemodynamic compromise. The risk-benefit of continuing chemotherapy vs VTE management should be discussed at MDT. Anticoagulation is continued for ≥6 months and while cancer is active.

Reference: NICE NG158 VTE; ESMO 2024; ISTH Cancer-Associated VTE Guidelines