Further results of the FRAGMATIC trial of thromboprophylaxis in lung cancer

The FRAGMATIC trial was a multi-centre, open-label study comparing the addition of a primary prophylactic daily dose of the low molecular weight heparin (LMWH), dalteparin, for 24 weeks to standard treatment in newly diagnosed lung cancer patients of any stage or histology (1). Its results were recently published and show that 24 weeks of daily thromboprophylactic dalteparin does not have a significant effect on overall survival at one year of newly diagnosed lung cancer patients. The entry criteria of the trial were wide and included patients with both small cell (SCLC) and non-small cell lung cancer (NSCLC) of any stage, receiving any treatment. A priori sub-group analyses were carried out and showed that there was unlikely to be a significant survival benefit for any of the following subgroups: sex, age, BMI, histological subtype or advanced stage. Of particular interest were the results for patients with SCLC because two small RCTs (2,3) had previously suggested that there might indeed be a survival benefit for these patients especially for those with limited disease. These results together with post hoc analyses of RCTs in other tumour types had raised the intriguing possibility that low molecular weight heparins might, in addition to having an antithrombotic effect, inhibit the development and progression of systemic metastases