Risk of Thrombo-Embolic Events in Ovarian Cancer: Does Bevacizumab Tilt the Scale? A Systematic Review and Meta-Analysis

Abstract

Thromboembolic events are the second cause of death in cancer patients. In ovarian cancer, 3–10% of patients present with venous thromboembolism (VTE), but the incidence may rise to 36% along the disease course. Bevacizumab is a monoclonal antibody directed against vascular endothelial-derived growth factor, and in in vitro studies it showed a predisposition to hemostasis perturbation, including thrombosis. However, in vivo and clinical studies have shown conflicting results for its use as a treatment for ovarian cancer, so we conducted a systematic review and meta-analysis on the risk of arterial thromboembolism (ATE) and VTE in ovarian cancer patients treated with bevacizumab. The review comprised 14 trials with 6221 patients: ATE incidence was reported in 5 (4811 patients) where the absolute risk was 2.4% with bevacizumab vs. 1.1% without (RR 2.45; 95% CI 1.27–4.27, p = 0.008). VTE incidence was reported in 9 trials (5121 patients) where the absolute risk was 5.4% with bevacizumab vs. 3.7% without (RR 1.32; 95% CI 1.02–1.79, p = 0.04). Our analysis showed that the risk of arterial and venous thromboembolism increased in patients treated with bevacizumab. Thrombolic events (TEs) are probably underreported, and studies should discriminate between ATE and VTE. Bevacizumab can be considered as an additional risk factor when selecting patients for primary prophylaxis with anticoagulants.

Nomogram prediction for the risk of venous thromboembolism in patients with lung cancer

“…Bevacizumab significantly increased the risk of VTE with an RR of 1.33 (95% CI 1.13–1.56; P < 0.001) compared with controls. Consequently, several recent studies concluded similar results in various cancer types [ 41 – 45 ]. Consistent with previous reports, our results demonstrated that bevacizumab was also identified as an independent risk factor for VTE with an OR of 3.14 (95% CI 1.46–6.77; P = 0.003).…”

Incidence and prevalence of drugs used for chronic diseases in survivors of adult‐onset gynaecological cancer – A nationwide cohort study

“…We found that both the incidence and prevalence of drugs used for thromboembolism were high in the gynaecological cancer survivors, particularly in women with cervical and ovarian cancer. The occurrence was not unexpected, as the incidence of venous thromboembolism for both patient populations is high 29,30 . The incidence was higher closer to the time of diagnosis, probably due to tumour‐related factors, but the prevalence remained high more than 10 years after.…”

“…The occurrence was not unexpected, as the incidence of venous thromboembolism for both patient populations is high. 29,30 The incidence was higher closer to the time of diagnosis, probably due to tumour-related factors, but the prevalence remained high more than 10 years after.…”

Prévention et prise en charge des thromboses associées au cancer: questions pratiques à propos de l’anticoagulation

“…Si le risque de thrombose artérielle induit par les conséquences de l'inhibition du facteur de croissance de l'endothélium vasculaire (VEGF) (formation d'un thrombus et altération de la fonction plaquettaire) est avéré, il ressort des données cliniques disponibles une augmentation du risque relatif (RR) de maladie thromboembolique veineuse modeste, de l'ordre de 1,3 chez les patients traités pour un cancer colorectal, qui n'est pas retrouvée chez les patients traités pour un cancer du sein ou un cancer bronchique non à petites cellules [30]. Un sur-risque a en revanche été observé chez des patientes traitées pour un cancer de l'ovaire (RR : 1,32 [IC 95 %, 1,02-1,79] ; p = 0,04) [34]. Selon une analyse de neuf études de phases 2 et 3, les inhibiteurs de l'EGFR comme le cétuximab ou le panitumumab seraient associés à une augmentation du risque de maladie thromboembolique veineuse et d'embolie pulmonaire de 50 % et 60 %, respectivement [35].…”