Apixaban (Eliquis) in Cancer-Associated Thrombosis

Apixaban, sold as Eliquis, is an oral factor Xa inhibitor best known for stroke prevention in atrial fibrillation and for treating venous thromboembolism (VTE). It matters for oncology because cancer itself, and many of its treatments, raise the risk of blood clots.

Mechanism at a glance

Apixaban selectively and reversibly inhibits factor Xa, blocking the conversion of prothrombin to thrombin. It is taken orally, usually twice daily, and has a relatively predictable effect without routine monitoring. Its reversal agent, andexanet alfa (Andexxa), is no longer sold in the US: AstraZeneca ended US sales on December 22, 2025 after the FDA concluded the risks outweighed the benefits, and trade press names off-label prothrombin complex concentrates as the remaining option.

Why oncology teams care

Cancer-associated thrombosis is a common and serious complication. For years, low-molecular-weight heparin injections were the standard. Direct oral anticoagulants offered an alternative, and trials in cancer populations, including the Caravaggio study of apixaban, supported its use as an oral option for treating cancer-associated VTE. The evidence base includes three trials. In Caravaggio, recurrent VTE occurred in 5.6% with apixaban vs 7.9% with dalteparin (noninferior), with major bleeding of 3.8% vs 4.0%. In AVERT, apixaban prophylaxis in ambulatory patients starting chemotherapy reduced VTE to 4.2% from 10.2% with placebo, but major bleeding was higher (3.5% vs 1.8%). In API-CAT (NEJM 2025), a reduced dose of 2.5 mg twice daily was noninferior to 5 mg for extended treatment (recurrent VTE 2.1% vs 2.8%), with less major or clinically relevant nonmajor bleeding (12.1% vs 15.6%). ASCO’s 2023 guideline update added apixaban as an option for treating VTE in patients with cancer.

The practical issues

Bleeding risk: particularly with gastrointestinal and genitourinary cancers, and with thrombocytopenia during chemotherapy.
Drug interactions: apixaban is affected by strong CYP3A4 and P-glycoprotein inhibitors and inducers, which appear in many oncology regimens.
Renal and hepatic function and body weight can alter dosing decisions.

The competitive angle

Apixaban competes with rivaroxaban, edoxaban and heparins, and its exclusivity is ending in stages. In the US, BMS says the generic companies it settled with are permitted to launch in 2028, subject to additional challenges. In the EU, BMS lists the composition-of-matter patents and related SPCs as expiring in November 2026. In the US, Medicare’s negotiated price took effect in January 2026: $231 per 30-day supply against a $521 list price. The longer-term story is the pipeline of factor XI inhibitors, which aim to separate antithrombotic benefit from bleeding. In cancer-associated thrombosis, the two Phase 3 trials of abelacimab (ASTER, against apixaban, and MAGNOLIA, against dalteparin) were terminated by the sponsor in early 2026; ClinicalTrials.gov gives “sponsor decision” as the reason, and Fierce Biotech reported the stop after the drug failed to beat Eliquis in a Phase 3 trial. Regeneron has since started Phase 3 trials of its factor XI antibody, REGN7508. Our cardiovascular colleagues have written about this class in the context of AFib and stroke prevention.

What to watch

Trials of factor XI inhibitors in cancer-associated thrombosis, guideline updates on prophylaxis, and the interplay between anticoagulants and new oncology drugs that affect clotting or platelets.

Recent developments

Updated October 8, 2026. Items are drawn from company announcements, regulators and trade press; links go to the sources.

Q2 2026: Bristol Myers Squibb reported Eliquis revenue of $4,481 million in Q2 2026 (vs $3,680 million) and $8,617 million for the first half (vs $7,245 million), up about 22%. (BMS 10-Q)
2026: Regeneron’s REGN7508 has two Phase 3 cancer-associated thrombosis programs listed on ClinicalTrials.gov: ROXI-CAT-I (prophylaxis in solid tumors on cancer therapy, started March 2026) and ROXI-CAT-II (treatment and secondary prevention of VTE, with apixaban as active control, start listed for August 2026). (ClinicalTrials.gov)
Early 2026: ClinicalTrials.gov lists both abelacimab cancer-associated thrombosis trials as terminated by the sponsor: ASTER (1,150 enrolled, against apixaban) and MAGNOLIA (417 enrolled, against dalteparin). (ClinicalTrials.gov)
Jan 1, 2026: The Medicare negotiated price for Eliquis took effect: $231 per 30-day supply vs a $521 list price, a 56% discount. (CMS)
Dec 22, 2025: AstraZeneca withdrew the Andexxa application and ended US commercial sales after the FDA concluded the risks outweighed the benefits; in ANNEXA-I, thrombosis occurred in 14.6% with Andexxa vs 6.9% with usual care. It remained conditionally approved in the EU and UK at the time of the report. (Pharmaphorum)
2025: API-CAT was published in the New England Journal of Medicine: in 1,766 patients with cancer and VTE who had completed at least six months of anticoagulation, apixaban 2.5 mg twice daily was noninferior to 5 mg for 12 months of extended treatment. (PubMed)
Apr 2023: ASCO’s VTE guideline update added apixaban as an option for treating VTE in patients with cancer. (PubMed)

Upcoming catalysts

Nov 2026: BMS lists the EU apixaban composition-of-matter patents and SPCs as expiring. Patent expiry is not the same as generic availability in every EU country.
2028: US generic entry is permitted under BMS settlements, subject to additional challenges. A separate Azurity 505(b)(2) patent suit is pending in Delaware.
2030-2031 (estimated): primary completion of the REGN7508 ROXI-CAT-I (January 2030) and ROXI-CAT-II (July 2031) trials, per ClinicalTrials.gov.

Bottom line

For oncology, apixaban is a supportive-care story with large commercial consequences. Anticoagulant choice affects chemotherapy scheduling, procedures and quality of life, so it is a practical area where oncology and cardiovascular intelligence overlap.

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This article is for informational and competitive-intelligence purposes only and is not medical advice. Approvals, labels and trial results change; verify details against current prescribing information and primary sources.