A study looking at whether aspirin and ticagrelor affect blood clotting and how cancer spreads (TICONC)

Cancer type:

All cancer types

Bowel (colorectal) cancer

Breast cancer

Colon cancer

Rectal cancer

Secondary cancers

Status:

Results

Phase:

Phase 1/2

This study was done to find out what effect aspirin and ticagrelor have on blood clotting cells and how cancer spreads.

The study was open for people to join between 2015 and 2018. The team published the results in 2020.

More about this trial

Cancer cells can enter the bloodstream and circulate around the body. Sometimes these cancer cells leave the bloodstream and start growing in different parts of the body. This is called metastases, or secondary cancer.

People with cancer have an increased risk of blood clotting problems (thrombosis).

Platelets help the blood to clot. Researchers know that circulating cancer cells interact with platelets in the blood. This may help protect the cancer cells and help them spread.

Aspirin and ticagrelor are both treatments that change how platelets work. When this trial was done they were already being used for people who didn’t have cancer, but had an increased risk of developing blood clots.

The research team wanted to find out more about what happens in people with cancer.

People taking part took either aspirin or ticagrelor to begin with. Then they had the other treatment. And then they had both together.

The main aims of this study were to find out if:

ticagrelor has an effect on the interaction between cancer cells and platelets
it’s better to have aspirin, ticagrelor or both together

Summary of results

The research team found that ticagrelor has the potential to help stop blood clots in some people with cancer.

Study design
There were 2 parts to this trial.

In part 1 the researchers looked at cells from blood samples in a laboratory. They looked at what happened to platelets with different doses of ticagrelor.

In part 2 the researchers looked at what happened to platelets and other clotting factors in people when they take aspirin and ticagrelor.

Results
A total of 113 people joined this study:

75 in part 1
38 in part 2

Some people taking part had cancer. But some people didn’t (healthy volunteers).

The research team took blood samples from the people in part 1. They analysed the interaction of platelets and cancer cells in the laboratory. This was to see what happened with different doses of ticagrelor.

They found that cancer cells cause the platelets to stick together. And that ticagrelor helped stop this happening more than aspirin did.

The people in part 2 had both aspirin and ticagrelor. They were put into 1 of 2 treatment groups at random. Some people had aspirin first, and some people had ticagrelor first. Then they had the other treatment. And then they had both treatments together.

Flow Chart 1

The research team looked at various things such as how cancer cells affected platelets. This included changes in factors on the surface of platelets, and substances released by platelets.

They also looked at how platelets stick together. Then they looked at the impact of ticagrelor and aspirin on all these factors.

The results showed that ticagrelor helped stop platelets sticking together in people with cancer more than aspirin did. And more than it did in people who didn’t have cancer. They think this may be an important potential way to reduce blood clots in people with cancer. And possibly to help stop cancer spreading to another part of the body.

Side effects
Some people who took part had side effects. But these were mostly mild or didn’t last long. The most common side effect was bruising or non serious bleeding.

One person decided to stop treatment because they had blood in their urine (haematuria).

Conclusion
The research team concluded that ticagrelor may help prevent blood clots in people with cancer who have an increased risk of clots.

They suggest more work is done to find out if ticagrelor can be used:

as a treatment to prevent blood clots in people with cancer
to help stop cancer spreading

More detailed information
There is more information about this research in the reference below.

Please note, this article may not be in plain English. It has been written for health care professionals and researchers.

The TICONC (Ticagrelor-Oncology) Study. Implications of P2Y12 Inhibition for Metastasis and Cancer-Associated Thrombosis
J Wright and others
Journals of the American College of Cardiology (JACC: CardioOncolgy), 2020.
Volume 2, Issue 2, pages 236 – 250.

Where this information comes from
We have based this summary on the information in the article above. This has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the link we list above is active and the article is free and available to view.