Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer

Abstract

ObjectivesNeoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.MethodsA multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.ResultsA total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).ConclusionsPatients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.

Procoagulant activity in high grade serous ovarian cancer patients following neoadjuvant chemotherapy-The role of the activated protein C pathway

“…Our group has shown that chemotherapy treatment is an independent risk factor for VTE in gynaecological cancer patients [7]. In a recent study, BMI, cancer stage and histological subtype were not found to be predictive of increased VTE risk in patients undergoing neoadjuvant chemotherapy, further highlighting the need for a greater understanding of the prothrombotic mechanisms involved in chemotherapy associated thrombosis [6]. The pathogenesis of chemotherapy associated thrombosis, particularly in the neoadjuvant setting, is unclear but a combination of tumour burden and treatment related factors are likely to be involved.…”

“…The cornerstone of ovarian cancer treatment is cytoreductive surgery followed by adjuvant chemotherapy, however patients who cannot be optimally debulked are frequently treated with neoadjuvant chemotherapy followed by interval debulking surgery which further exacerbates VTE risk. High rates of VTE have been reported in ovarian cancer patients who undergo neoadjuvant chemotherapy [6]. In addition, ovarian cancer patients who experience a VTE during neoadjuvant chemotherapy having a longer mean time to surgery.…”

Nurses’ knowledge, attitudes, and behaviors toward venous thromboembolism prophylaxis: How to do better

“…1 VTE is a complication in pathology or pregnancy and can lead to a high death rate. 2,3 This disease is the major cause of death among cancer patients accounting for 9% of all maternal deaths. 4,5 In-patients can increase the risk of DVT by 10–40% without any prevention, and even reach 60–80% in orthopedics wards.…”

Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis

“…Six included studies encompassing 718 patients reported on the prevalence of VTE in ovarian cancer patients undergoing chemotherapy [ 40 , 79 , 82 , 96 , 115 , 121 ]. The meta-analysis revealed a pooled estimated prevalence of 8%, ranging from 5% to 12% (ES 8%; 95% CI 5–12%; z = 7.47; p = 0.02) ( Table 4 and Supplemental SI Figure S9 ).…”