Cancer-associated ThrombosisPhase 3API-CATNCT03692065
API-CAT STUDY for APIxaban Cancer Associated Thrombosis
A Phase 3 study testing Apixaban 5 MG in people with Cancer-associated Thrombosis, run by Assistance Publique - Hôpitaux de Paris at 114 sites in 11 countries.
Trial summary
The main objective is to determine whether a low-dose regimen of apixaban (2.5 mg bid) is non inferior to a full-dose regimen of apixaban (5 mg bid) for the prevention of recurrent venous thromboembolism (VTE) in patients with active cancer who have completed at least 6 months of anticoagulant therapy for treating a… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Cancer-associated Thrombosis
- What is being tested?
- Apixaban 5 MG
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 1,766 participants
- Where
- 114 sitesin 11 countries
- Study dates
- 11 Oct 2018to 20 Oct 2024
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Signed written informed consent
- Any cancer diagnosed histologically (other than basal-cell or squamous-cell carcinoma of the skin, primary brain tumor or intra-cerebral metastasis)
- Active cancer defined as the presence of measurable disease or ongoing (or planned) chemotherapy, radiotherapy, hormonotherapy, targeted therapy, immunotherapy at inclusion
- Objectively documented index event : Symptomatic or incidental proximal lower-limb, iliac, inferior vena cava DVT or symptomatic or incidental pulmonary embolism in a segmental or larger pulmonary artery or incidental PE in a segmental or larger pulmonary artery
- Proximal DVT is defined as DVT that involves at least the popliteal vein or a more proximal vein, demonstrated by imaging with compression ultrasound (CUS), including grey-scale or color-coded Doppler, or ascending contrast venography or contrast enhanced computed tomography or magnetic resonance imaging
- PE has to be demonstrated by imaging as follows:
Show all 14Show fewer
- an intraluminal filling defect in segmental or more proximal branches on contrast enhanced chest computed tomography or on computed tomography pulmonary angiography; or
- an intraluminal filling defect or a sudden cutoff of vessels more than 2.5 mm in diameter on the pulmonary angiogram; or
- a perfusion defect of at least 75% of a segment with a local normal ventilation result (high-probability) on ventilation/perfusion lung scan (VPLS)
- Incidental VTE is defined as proximal DVT or PE detected by imaging incidentally when a patient undergoes imaging studies as standard of care for the management of his or her malignancy or other reasons but not for a VTE suspicion(e.g. cancer diagnosis or staging).
- Completed at least 6 months of anticoagulant therapy at therapeutic dosage (whatever the drug and the dosing),or completed assigned a clinical trial study treatment, for the treatment of the index event and patient still receiving anticoagulant treatment 6 months after occurrence of the VTE index
- No objectively documented symptomatic recurrence of VTE between the index event and randomization.
- Anticipated duration of anticoagulant treatment of at least 12 months at the time of randomization
- Patient affiliated to social security for French centers.
Who cannot join
- WOCBP who are unwilling or unable to use an acceptable method of birth control [such as oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (condoms)] to avoid pregnancy for the entire study
- Women who are pregnant or breastfeeding
- Women with a positive pregnancy test on enrollment or prior to investigational product administration
- Isolated sub-segmental (incidental or symptomatic) PE without associated DVT
- Isolated distal DVT of the legs
- Isolated upper-extremity DVT or superior vena cava thrombosis
Show all 35Show fewer
- Isolated visceral thrombosis
- Isolated catheter thrombosis
- Objectively documented symptomatic recurrence of VTE after the index event under anticoagulant treatment
- VTE during anticoagulant treatment given at therapeutic dosage
- Subjects with indications for long-term treatment with a VKA, such as:
- Mechanical heart valve
- Antiphospholipid syndrome
- Subjects with indication for long-term anticoagulation with a VKA or a DOAC at therapeutic dosage
- Conditions increasing the risk of serious bleeding
- intracranial or intraocular bleeding within the 6 months
- major surgery within 2 weeks prior to randomization
- overt major bleeding at time of randomization
- Life expectancy < 12 months
- Eastern Cooperative Oncology Group (ECOG) level 3 or 4
- Bacterial endocarditis
- Uncontrolled hypertension: systolic blood pressure >180 mm Hg or diastolic blood pressure >110 mm Hg
- Platelet count < 75,000/mm3
- Hemoglobin < 8g /dl
- Creatinine clearance < 30 ml /min based on the Cockcroft Gault equation
- Acute hepatitis, chronic active hepatitis, liver cirrhosis; or an alanine aminotransferase level 3 times or more and/or bilirubin level 2 times or more higher the upper limit of the normal range
- Subjects requiring acetylsalicylic acid >165 mg/day at randomization or thienopyridine therapy (clopidogrel, prasugrel, or ticagrelor).
- Subjects requiring dual anti-platelet therapy (such as acetylsalicylic acid plus clopidogrel or acetylsalicylic acid plus ticlopidine) at randomization. Subjects who transition from dual antiplatelet therapy to monotherapy prior to randomization will be eligible for the trial.
- Concomitant use of strong inhibitors of both cytochrome P-450 3A4 and P Glycoprotein (e.g., human immunodeficiency virus protease inhibitors or systemic ketoconazole) or strong inducers of both cytochrome P450 3A4 and P Glycoprotein (e.g.,rifampicin, carbamazepine, or phenytoin).
- Prisoners or subjects who are involuntarily incarcerated
- Subjects who are compulsorily detained for treatment of either a psychiatric or physical (eg, infectious disease) illness
- Hypersensitivity to apixaban
- Subjects participating in another pharmaco therapeutic program with an experimental therapy that is known to affect the coagulation system
- Under 18 years old
- Patients under legal protection (guardianship).
Trial locations and contacts
114 sites in 11 countries.
114 sites in 11 countries
France68 sites
C.H.U. D'Amiens Picardie
Amiens, 80054
Chu D'Angers
Angers, 49033
HÔPITAL PRIVÉ ARRAS LES BONNETTES - Espace Artois Santé
Arras, 62012
Centre Hospitalier d'Avignon
Avignon, 84000
Institut Sainte Catherine
Avignon, 84918
Hopital Jean Minjoz
Besançon, 25030
Hôpital AVICENNE - APHP
Bobigny, 93009
Hopital Saint Andre
Bordeaux, 33075
Institut Bergonie
Bordeaux, 33076
Hôpital d'Instruction des Armées Clermont Tonnerre
Brest, 29240
Chru Brest - Hopital Morvan
Brest, 29609
Chru Brest- Hopital Cavale Blanche
Brest, 29609
Centre François Baclesse
Caen, 14000
Centre de Recherche Clinique
Caen, 14033
Hopital Cote de Nacre
Caen, 14033
Clinique Du Parc
Castelnau-le-Lez, 34171
Centre hospitalier Métropole Savoie
Chambéry, 73000
Ch Cholet
Cholet, 49300
Hia Percy
Clamart, 92190
Hopital Gabriel Montpied
Clermont-Ferrand, 63003
Hôpital BEAUJON - APHP
Clichy, 92110
Hopital Louis Mourier - APHP
Colombes, Île-de-France Region, 92700
Hôpital Henri Mondor
Créteil, 94000
Hôpital HENRI MONDOR - APHP
Créteil, 94010
CHU DIJON BOURGOGNE - Hôpital François Mitterrand
Dijon, 21079
Chu de Grenoble
Grenoble, 38043
Chd Vendee
La Roche-sur-Yon, 85025
Centre Hospitalier Du Mans
Le Mans, 72037
Centre hospitalier Emile Roux
Le Puy-en-Velay, 43000
Chu de Limoges
Limoges, 87042
Centre Leon Berard
Lyon, 69008
Hôpital Prive Jean Mermoz
Lyon, 69008
Clinique de l'Infirmerie Protestante de Lyon
Lyon, 69300
Hopital La Timone Adultes
Marseille, 13385
Groupe hospitalier sud Ile de France
Melun, 77000
Hopital Saint- Eloi
Montpellier, 34000
C.H. Des Pays de Morlaix
Morlaix, 29600
Centre D Oncologie de Gentilly
Nancy, 54000
CHU DE Nantes - Site Hotel Dieu
Nantes, 44035
Chu de Nice
Nice, 06001
Institut Curie
Paris, 75005
Hôpital Saint Antoine - APHP
Paris, 75012
Hôpital PITIE SALPETRIERE - APHP
Paris, 75013
Hôpital COCHIN - APHP
Paris, 75014
Hôpital GEORGES POMPIDOU - APHP
Paris, 75015
Hôpital Bichat Claude Bernard
Paris, 75018
Hopital Tenon - Aphp
Paris, 75020
Hopital Saint-Joseph
Paris, 75674
Centre Hospitalier Lyon-Sud
Pierre-Bénite, 69495
Polyclinique de Courlancy
Reims, 51057
CHU de Rennes
Rennes, 35000
Centre Anti-Cancereux E. Marquis
Rennes, 35042
Chu de Rouen - Hopital Charles Nicolle
Rouen, 76038
Centre Rene Huguenin
Saint-Cloud, 92210
Hôpital Nord
Saint-Etienne, 42055
C.H.I Poissy-Saint Germain
Saint-Germain-en-Laye, 78105
Centre Hospitalier de Saint Malo
St-Malo, 35400
Clinique de l' Estrée
Stains, 93240
Clinique Saint Anne
Strasbourg, 67000
Centre Paul Strauss
Strasbourg, 67085
Hopital Foch
Suresnes, 92151
Chi de Toulon La Seyne
Toulon, 83056
Iuct Oncopole
Toulouse, 31059
Hopital Andre Mignot
Versailles, 78000
L'Hôpital Nord-Ouest
Villefranche-sur-Saône, 69655
Hôpital Paul Brousse - APHP
Villejuif, 94800
Institut Gustave Roussy
Villejuif, 94805
Médipôle Hôpital Mutualiste
Villeurbanne, 69616
Spain11 sites
Hospital genarl Univ de Albacete
Albacete
Hospital Virgen de los lirios
Alicante
Fundacio Hospital de L'Esperit Sant
Barcelona
Hospital universitari Germans trias i Pujol
Barcelona
Parc Santari Sant Joan de Deu - Hospital general
Barcelona
Hospital general Universitario Santa Lucia
Cartagena
Hospital general universitario de ciudad real
Ciudad Real
Hospital Olot i Comarcal de ma Garrotxa
Girona
Hospital universitari de Girona
Girona
Hospital universitario Infanta Sofia
Madrid
Hospital universitario Virgen del Rocio
Seville
Belgium7 sites
Erasmus Hospital Brussel
Brussels
Institut Roi Albert II
Brussels
AZ Groeninge
Kortrijk
Uz Leuven
Leuven
CHC Saint-Joseph
Liège
CHR de la Citadelle
Liège
CHU de Liège
Liège
Netherlands7 sites
Amsterdam university medical center
Amsterdam
Gelre Ziekenhuizen Apeldoorn
Apeldoorn
Rode Kruis Ziekenhuis
Beverwijk
Albert Schweitzer Ziekenhuis
Dordrecht
Tergooi Hospital Hilversum
Hilversum
Leiden university medical center
Leiden
Diakonessenhuis
Utrecht
Canada5 sites
University of Calgary
Calgary, T2N 2T9
University of Alberta
Edmonton, AB T6G 2R3
Ottawa Hospital Research Institute OTTAWA
Ottawa, ON K1Y 4E9
Toronto General Hospital
Toronto, M5G2C4
Diamond Health Care Centre
Vancouver, BC V5Z 1M9
Austria4 sites
Medical university of Graz
Graz
Medical university of Innsbruck
Innsbruck
Ordensklinikum Linz gmbH Elisabethinen
Linz
Medical university of Vienna
Vienna
Greece4 sites
Athens School of Medicine
Athens
National and Kapodistrian University of Athens ALEXANDRA Hospital
Athens
University General Hospital "Attikon"
Athens
University of Athens
Athens
Italy3 sites
Ospedale di Castelfranco Veneto
Castelfranco Veneto
Opedale clinicizzato colle dell'ara
Chieti
Universita di Perugia
Perugia
Switzerland3 sites
Istituto Oncologico della svizzera Italiana
Bellinzona
Hopitaux universitaires de Genève
Geneva
Lausanne university hospital - CHUV
Lausanne
Poland1 site
Centre of postgraduate medical education at the european health centre Otwock
Otwock
About this study
Official title: Long-term Treatment of Cancer Associated VTE: Reduced vs Full Dose of Apixaban : API-CAT STUDY for APIxaban Cancer Associated Thrombosis
The main objective is to determine whether a low-dose regimen of apixaban (2.5 mg bid) is non inferior to a full-dose regimen of apixaban (5 mg bid) for the prevention of recurrent venous thromboembolism (VTE) in patients with active cancer who have completed at least 6 months of anticoagulant therapy for treating a documented index event of proximal deep venous thrombosis (DVT) (symptomatic or incidental) or pulmonary embolism (symptomatic or incidental).
Read the detailed description
For patients completing at least 6 months of anticoagulant therapy in whom the cancer is active, the thrombotic risk is arguably ongoing and indefinite anticoagulation seems required.
Given apixaban 5 mg bid is an alternative for the first 6 months of treatment, we intend to assess whether it is possible to lower the dose of apixaban (2.5 mg bid) after completing at least 6 months of anticoagulant treatment in a specific population of patients with cancer associated thrombosis (CAT) requiring extended anticoagulant treatment and with significant life expectancy. There are 2 conditions to be met : demonstrate the non-inferiority of the 2.5 mg bid regimen on the efficacy endpoint and then demonstrate the superiority of the 2.5 mg bid regimen as compared to the 5 mg bid on the safety endpoint.
It is a multicenter, international, prospective, randomized, parallel-group, double-blind non-inferiority trial with blinded adjudication of outcome events (approximately 160 centers in approximately 10 countries (France, Italy, Spain, Belgium, Greece, Netherlands, UK, Switzerland, Poland, Austria), with a number of expected inclusions of 11 patients per site.
Subjects should be randomized within 7 days after the last dose of their initial 6-month treatment, defined as the treatment ongoing after completing at least 6 months of anticoagulant treatment from the beginning of the anticoagulant treatment for the index event. This treatment may be low-molecular weight heparin (LMWH), direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). If a VKA was used as standard anticoagulant therapy, then an INR must be documented as 2 or less before randomization. Every attempt should be made to randomize subjects as soon as possible after the initial treatment has been discontinued.
Subjects will be stratified based on the cancer site and the type of disease treated (PE with/without DVT or DVT alone). If a subject had both symptomatic DVT and symptomatic PE, the subject will be stratified as having symptomatic PE.
- Conditions
- Cancer-associated Thrombosis
- Being tested
- Apixaban 5 MG
- Keywords
- Cancer, VTE, Apixaban, Thrombosis
- Medical subject headings
- Neoplasms, Thrombosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Apixaban 5 MGDrug
Also called Apixaban 2.5 MG
Subjects will be randomized (1:1 ratio) to apixaban 5 mg bid (full dose) or apixaban 2.5 mg bid (reduced-dose) using a centralized IWRS (double blind study).
| Study group | Role | What they receive |
|---|---|---|
| Apixaban film coated tablets 2.5 mg | Active comparator | Patients randomized in the apixaban reduced dose group will receive an apixaban 2.5 mg tablet and a placebo of apixaban 5 mg tablet, twice daily for 12 months. Receives: Drug: Apixaban 5 MG |
| Apixaban film coated tablets 5 mg | Active comparator | Patients randomized in the apixaban full dose group will receive a placebo of apixaban 2.5 mg tablet and an apixaban 5 mg tablet, twice daily for 12 months. Receives: Drug: Apixaban 5 MG |
What is being measured
The primary outcome is the main question the study is designed to answer.
The incidence of an an adjudicated composite endpoint
The incidence of an adjudicated composite of recurrent symptomatic VTE (proximal and/or distal DVT and/or symptomatic PE and/or upper limb or central venous catheter thrombosis or incidental VTE (proximal DVT or PE), or death due to PE during the treatment period.
Incidental VTE is defined as proximal DVT or PE detected by imaging incidentally when a patient undergoes imaging studies as standard of care for the management of the malignancy or other reasons but not for a VTE suspicion.
Measured: During the treatment period (12 months)
Secondary outcomes (6)
The incidence of adjudicated major and clinically relevant non-major bleeding
The definition of major bleeding described is adapted from the International Society on Thrombosis and Hemostasis (ISTH) definition (Schulman JTH 2005).
Measured: During the treatment period (12 months)
Recurrent symptomatic VTE
Recurrent VTE objectively confirmed after clinical suspicion
Measured: During the treatment period (12 months)
VTE related-death
VTE related-death: PE based on objective diagnostic testing, autopsy, or sudden death; i.e. death occurring within one hour of the onset of new symptoms which cannot be attributed to a documented cause (unexplained death) and for which PE/DVT cannot be ruled out as the cause.
Measured: During the treatment period (12 months)
All-cause death
All deaths will be adjudicated by the ICAC and classified as either VTE-related, cancer death (including all deaths due to the underlying cancer), bleeding-related or others, including all deaths due to a clearly documented other cause, such as respiratory failure (e.g., terminal emphysema), infections/sepsis etc.
Measured: During the treatment period (12 months)
Adjudicated major bleeding.
The definition of major bleeding described is adapted from the International Society on Thrombosis and Hemostasis (ISTH) definition (Schulman 2005) and includes
- Acute clinically overt bleeding with one or more of the following:
- A decrease in hemoglobin (Hgb) of 2 g/dL or more
- A transfusion of 2 or more units of packed red blood cells
- Symptomatic bleeding that occurs in at least one of the following critical sites:
- Intracranial
- Intraspinal
- Intraocular (within the corpus of the eye; thus, a conjunctival bleed is not an intraocular bleed)
- Pericardial
- Intra-articular
- Intramuscular with compartment syndrome
- Retroperitoneal
- Bleeding that is fatal: bleeding event that the independent adjudication committee determines is the primary cause of death or contributes directly to death.
Measured: During the treatment period (12 months)
Adjudicated composite of recurrent symptomatic VTE, VTE related-death, all-cause death, adjudicated major bleeding.
Adjudicated composite of recurrent symptomatic VTE, VTE related-death, all-cause death, adjudicated major bleeding.
Measured: During the treatment period (12 months)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Oct 2018
- Study start11 Oct 2018
- Primary completion6 Sep 2024
- Study completion20 Oct 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (3)Papers the sponsor has linked to this study.
- Other trials for Cancer-associated ThrombosisStudies of the same condition, open and under way.
- More trials run by Assistance Publique - Hôpitaux de ParisThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 1,766 participants (actual)
Sponsor and investigators
- Lead sponsor
- Assistance Publique - Hôpitaux de Paris
- Sponsor type
- University, hospital or other
- Collaborators
- Bristol-Myers Squibb
- Responsible party
- Sponsor
- Investigators
- Guy Meyer, Pr, Study director, APHP(ASSISTANCE PUBLIQUE DES HOPITAUX DE PARIS
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03692065
- Sponsor's protocol ID
- P170604J
- Acronym
- API-CAT
- Status last verified
- Feb 2025
- First submitted
- 28 Sep 2018
- Last updated
- 6 Feb 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Mahe I, Happe F, Monreal M, Robert-Ebadi H, Debourdeau P, Fabreguettes JR, Accassat S, Mismetti P, Girard P, Laporte S, Chapelle C. API-CAT investigators' decisions on anticoagulation following extended treatment for cancer-associated thrombosis. Eur Heart J Cardiovasc Pharmacother. 2026 Sep 22;12(6):447-457. doi: 10.1093/ehjcvp/pvag046.
PubMed 42361291Mahe I, Chapelle C, Girard P, Carrier M, Palomares LJ, Samama CM, Helfer H, Gerotziafas G, Laporte S, Vicaut E, Mismetti P; API-CAT Study Group; API-CAT Investigators. Predictors of clinically relevant bleeding during extended anticoagulation for cancer-associated venous thromboembolism (API-CAT): a post-hoc analysis of a randomised, non-inferiority trial. Lancet Haematol. 2026 Jan;13(1):e41-e48. doi: 10.1016/S2352-3026(25)00291-1. Epub 2025 Dec 6.
PubMed 41365312Mahe I, Carrier M, Mayeur D, Chidiac J, Vicaut E, Falvo N, Sanchez O, Grange C, Monreal M, Lopez-Nunez JJ, Otero-Candelera R, Le Gal G, Yeo E, Righini M, Robert-Ebadi H, Huisman MV, Klok FA, Westerweel P, Agnelli G, Becattini C, Bamias A, Syrigos K, Szmit S, Torbicki A, Verhamme P, Maraveyas A, Cohen AT, Ay C, Chapelle C, Meyer G, Couturaud F, Mismetti P, Girard P, Bertoletti L, Laporte S; API-CAT Investigators. Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism. N Engl J Med. 2025 Apr 10;392(14):1363-1373. doi: 10.1056/NEJMoa2416112. Epub 2025 Mar 29.
PubMed 40162636
Study at a glance
From the registry record, last updated by the sponsor on 6 Feb 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Long-term Treatment of Cancer Associated VTE: Reduced vs Full Dose of Apixaban : API-CAT STUDY for APIxaban Cancer Associated Thrombosis
- ClinicalTrials.gov ID
- NCT03692065
- Acronym / sponsor ID
- API-CAT / P170604J
- Conditions
- Cancer-associated Thrombosis
- Keywords
- Cancer, VTE, Apixaban, Thrombosis
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 1,766 participants (actual)
- Lead sponsor
- Assistance Publique - Hôpitaux de ParisUniversity, hospital or other
- Collaborators
- Bristol-Myers Squibb
- Study start
- 11 Oct 2018 (actual)
- Primary completion
- 6 Sep 2024 (actual)
- Study completion
- 20 Oct 2024 (actual)
- First posted
- 2 Oct 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The main objective is to determine whether a low-dose regimen of apixaban (2.5 mg bid) is non inferior to a full-dose regimen of apixaban (5 mg bid) for the prevention of recurrent venous thromboembolism (VTE) in patients with active cancer who have completed at least 6 months of anticoagulant therapy for treating a documented index event of proximal deep venous thrombosis (DVT) (symptomatic or incidental) or pulmonary embolism (symptomatic or incidental).
Detailed description
For patients completing at least 6 months of anticoagulant therapy in whom the cancer is active, the thrombotic risk is arguably ongoing and indefinite anticoagulation seems required.
Given apixaban 5 mg bid is an alternative for the first 6 months of treatment, we intend to assess whether it is possible to lower the dose of apixaban (2.5 mg bid) after completing at least 6 months of anticoagulant treatment in a specific population of patients with cancer associated thrombosis (CAT) requiring extended anticoagulant treatment and with significant life expectancy. There are 2 conditions to be met : demonstrate the non-inferiority of the 2.5 mg bid regimen on the efficacy endpoint and then demonstrate the superiority of the 2.5 mg bid regimen as compared to the 5 mg bid on the safety endpoint.
It is a multicenter, international, prospective, randomized, parallel-group, double-blind non-inferiority trial with blinded adjudication of outcome events (approximately 160 centers in approximately 10 countries (France, Italy, Spain, Belgium, Greece, Netherlands, UK, Switzerland, Poland, Austria), with a number of expected inclusions of 11 patients per site.
Subjects should be randomized within 7 days after the last dose of their initial 6-month treatment, defined as the treatment ongoing after completing at least 6 months of anticoagulant treatment from the beginning of the anticoagulant treatment for the index event. This treatment may be low-molecular weight heparin (LMWH), direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). If a VKA was used as standard anticoagulant therapy, then an INR must be documented as 2 or less before randomization. Every attempt should be made to randomize subjects as soon as possible after the initial treatment has been discontinued.
Subjects will be stratified based on the cancer site and the type of disease treated (PE with/without DVT or DVT alone). If a subject had both symptomatic DVT and symptomatic PE, the subject will be stratified as having symptomatic PE.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Apixaban film coated tablets 2.5 mg | Active comparator | Drug: Apixaban 5 MGPatients randomized in the apixaban reduced dose group will receive an apixaban 2.5 mg tablet and a placebo of apixaban 5 mg tablet, twice daily for 12 months. |
| Apixaban film coated tablets 5 mg | Active comparator | Drug: Apixaban 5 MGPatients randomized in the apixaban full dose group will receive a placebo of apixaban 2.5 mg tablet and an apixaban 5 mg tablet, twice daily for 12 months. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (14 listed)
- Signed written informed consent
- Any cancer diagnosed histologically (other than basal-cell or squamous-cell carcinoma of the skin, primary brain tumor or intra-cerebral metastasis)
- Active cancer defined as the presence of measurable disease or ongoing (or planned) chemotherapy, radiotherapy, hormonotherapy, targeted therapy, immunotherapy at inclusion
- Objectively documented index event : Symptomatic or incidental proximal lower-limb, iliac, inferior vena cava DVT or symptomatic or incidental pulmonary embolism in a segmental or larger pulmonary artery or incidental PE in a segmental or larger pulmonary artery
- Completed at least 6 months of anticoagulant therapy at therapeutic dosage (whatever the drug and the dosing),or completed assigned a clinical trial study treatment, for the treatment of the index event and patient still receiving anticoagulant treatment 6 months after occurrence of the VTE index
Key exclusion criteria (35 listed)
- WOCBP who are unwilling or unable to use an acceptable method of birth control [such as oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (condoms)] to avoid pregnancy for the entire study
- Women who are pregnant or breastfeeding
- Women with a positive pregnancy test on enrollment or prior to investigational product administration
- Isolated sub-segmental (incidental or symptomatic) PE without associated DVT
- Isolated distal DVT of the legs
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Apixaban 5 MGAlso: Apixaban 2.5 MGSubjects will be randomized (1:1 ratio) to apixaban 5 mg bid (full dose) or apixaban 2.5 mg bid (reduced-dose) using a centralized IWRS (double blind study). | Drug | Apixaban film coated tablets 2.5 mg, Apixaban film coated tablets 5 mg |
Primary outcome
The incidence of an an adjudicated composite endpoint
Time frame: During the treatment period (12 months)
The incidence of an adjudicated composite of recurrent symptomatic VTE (proximal and/or distal DVT and/or symptomatic PE and/or upper limb or central venous catheter thrombosis or incidental VTE (proximal DVT or PE), or death due to PE during the treatment period. Incidental VTE is defined as proximal DVT or PE detected by imaging incidentally when a patient undergoes imaging studies as standard of care for the management of the malignancy or other reasons but not for a VTE suspicion.
6 secondary outcomes
The incidence of adjudicated major and clinically relevant non-major bleeding
Time frame: During the treatment period (12 months)
Recurrent symptomatic VTE
Time frame: During the treatment period (12 months)
VTE related-death
Time frame: During the treatment period (12 months)
All-cause death
Time frame: During the treatment period (12 months)
Adjudicated major bleeding.
Time frame: During the treatment period (12 months)
Adjudicated composite of recurrent symptomatic VTE, VTE related-death, all-cause death, adjudicated major bleeding.
Time frame: During the treatment period (12 months)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 6 Feb 2025.
- Derived from this study: PubMed 42361291Mahe I, Happe F, Monreal M, Robert-Ebadi H, Debourdeau P, Fabreguettes JR, Accassat S, Mismetti P, Girard P, Laporte S, Chapelle C. API-CAT investigators' decisions on anticoagulation following extended treatment for cancer-associated thrombosis. Eur Heart J Cardiovasc Pharmacother. 2026 Sep 22;12(6):447-457. doi: 10.1093/ehjcvp/pvag046.
- Derived from this study: PubMed 41365312Mahe I, Chapelle C, Girard P, Carrier M, Palomares LJ, Samama CM, Helfer H, Gerotziafas G, Laporte S, Vicaut E, Mismetti P; API-CAT Study Group; API-CAT Investigators. Predictors of clinically relevant bleeding during extended anticoagulation for cancer-associated venous thromboembolism (API-CAT): a post-hoc analysis of a randomised, non-inferiority trial. Lancet Haematol. 2026 Jan;13(1):e41-e48. doi: 10.1016/S2352-3026(25)00291-1. Epub 2025 Dec 6.
- Derived from this study: PubMed 40162636Mahe I, Carrier M, Mayeur D, Chidiac J, Vicaut E, Falvo N, Sanchez O, Grange C, Monreal M, Lopez-Nunez JJ, Otero-Candelera R, Le Gal G, Yeo E, Righini M, Robert-Ebadi H, Huisman MV, Klok FA, Westerweel P, Agnelli G, Becattini C, Bamias A, Syrigos K, Szmit S, Torbicki A, Verhamme P, Maraveyas A, Cohen AT, Ay C, Chapelle C, Meyer G, Couturaud F, Mismetti P, Girard P, Bertoletti L, Laporte S; API-CAT Investigators. Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism. N Engl J Med. 2025 Apr 10;392(14):1363-1373. doi: 10.1056/NEJMoa2416112. Epub 2025 Mar 29.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Guy Meyer, Pr study director
APHP(ASSISTANCE PUBLIQUE DES HOPITAUX DE PARIS
114 sites in 11 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Apixaban 5 MG in people with Cancer-associated Thrombosis, run by Assistance Publique - Hôpitaux de Paris at 114 sites in 11 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 14 inclusion and 35 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 6 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 114 sites in France, Spain, Belgium, Netherlands, Canada and 6 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The incidence of an an adjudicated composite endpoint (time frame: During the treatment period (12 months)). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03692065, which also lists 3 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Feb 2025.