Mauriello Alfredo, Maratea Anna Chiara, Fonderico Celeste, Quagliariello Vincenzo, Maurea Fabrizio, Maurea Nicola
Division of Cardiology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via M. Semmola, 52, 80131 Naples, Italy.
Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini, 5, 80131 Naples, Italy.
J Clin Med. 2025 Sep 8;14(17):6341. doi: 10.3390/jcm14176341.
Thrombotic complications are a common cause of morbidity and mortality in cancer patients. Factor XI (FXI) appears to play a direct role not only in thrombotic pathogenesis but also in cancer progression. This comprehensive review aims to define the pathophysiological relationships between FXI and cancer and to assess existing therapeutic opportunities targeting this factor. This review highlights how FXI is implicated in tumor growth, tumor cell adhesion and migration, inflammation, and angiogenesis. FXI inhibition has been shown to reduce the risk of thrombosis, with a potentially improved safety profile in terms of bleeding risk. Several molecules, such as asundexian and abelacimab, are in clinical trials for the prevention and treatment of venous thromboembolic events, catheter-related thrombosis, and arterial thromboembolic events in cancer patients. In conclusion, factor XI is closely linked to the pathogenesis of cancer and its thromboembolic complications. The use of FXI inhibitors emerges as a promising therapeutic strategy, offering potentially positive effects in the prevention and treatment of thromboembolic complications without significantly increasing the risk of bleeding, a limitation of conventional anticoagulants. The preliminary evidence is that further clinical trials are required and that the available data is not enough to make firm clinical recommendations.
血栓形成并发症是癌症患者发病和死亡的常见原因。凝血因子 XI（FXI）似乎不仅在血栓形成的发病机制中起直接作用，而且在癌症进展中也起直接作用。这篇综述旨在明确 FXI 与癌症之间的病理生理关系，并评估针对该因子的现有治疗机会。本综述重点介绍了 FXI 如何参与肿瘤生长、肿瘤细胞黏附与迁移、炎症和血管生成。已证明抑制 FXI 可降低血栓形成风险，在出血风险方面可能具有更好的安全性。几种分子，如阿孙西单抗和阿贝西单抗，正在进行临床试验，用于预防和治疗癌症患者的静脉血栓栓塞事件、导管相关血栓形成和动脉血栓栓塞事件。总之，凝血因子 XI 与癌症及其血栓栓塞并发症的发病机制密切相关。使用 FXI 抑制剂成为一种有前景的治疗策略，在预防和治疗血栓栓塞并发症方面可能具有积极作用，而不会显著增加出血风险，这是传统抗凝剂的一个局限性。初步证据表明需要进一步开展临床试验，且现有数据不足以做出明确的临床推荐。
