The Khorana score and venous and arterial thrombosis in patients with cancer treated with immune checkpoint inhibitors: A Danish cohort study

Overvad, Thure Filskov; Skjøth, Flemming; Piazza, Gregory; Noble, Simon; Ording, Anne Gulbech; Larsen, Torben Bjerregaard; Nielsen, Peter Brønnum

doi:10.1111/jth.15883

Cited by 11 publications

(5 citation statements)

References 51 publications

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“…The Khorana model has been extensively validated and employed in clinical settings, and the Vienna model has been reported as applicable for predicting VTE risk across various malignancies. 28 , 29 However, these models incorporate the location of the malignancy as one of the risk factors, despite the fact that the VTE risk varies considerably across different tumor sites, and the underlying mechanisms differ significantly. The use of such predictive models may obscure the predictive influence of certain risk factors on specific tumors.…”

Section: Discussionmentioning

confidence: 99%

Construction and Validation of a Nomogram to Predict the Postoperative Venous Thromboembolism Risk in Patients with HGSOC

Huang,

Li,

Gong

et al. 2024

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is a common complication in patients with high-grade serous ovarian cancer (HGSOC) after surgery. This study aims to establish a comprehensive risk assessment model to better identify the potential risk of postoperative VTE in HGSOC. Clinical data from 587 HGSOC patients who underwent surgical treatment were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify independent factors influencing the occurrence of postoperative VTE in HGSOC. A nomogram model was constructed in the training set and further validated in the verification set. Logistic regression identified age (odds ratio [OR] = 1.063, P = .002), tumor size (OR = 3.815, P < .001), postoperative transfusion (OR = 5.646, P = .001), and postoperative D-dimer (OR = 1.246, P = .003) as independent risk factors for postoperative VTE in HGSOC patients. A nomogram was constructed using these factors. The receiver operating characteristic curve showed an area under the curve (AUC) of 0.840 (95% confidence interval [CI]: 0.782, 0.898) in the training set and 0.793 (95% CI: 0.704, 0.882) in the validation set. The calibration curve demonstrated a good consistency between model predictions and actual results. The decision curve analysis indicated the model benefits at a threshold probability of less than 70%. A nomogram predicting postoperative VTE in HGSOC was established and validated. This model will assist clinicians in the early identification of high-risk patients, enabling the implementation of appropriate preventive measures.

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Section: Discussionmentioning

confidence: 99%

Construction and Validation of a Nomogram to Predict the Postoperative Venous Thromboembolism Risk in Patients with HGSOC

Huang,

Li,

Gong

et al. 2024

Clin Appl Thromb Hemost

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“…Thrombosis in ICI patients was evaluated in three Danish population cohort studies. 8,19,20 Two reported both ATE and VTE, 19,20 whereas one reported only VTE. 8 These studies reported a 2-4% VTE rate at 6 months and a 4-7% rate at 12 months, lower than retrospective studies.…”

Section: Incidence Of Venous Thromboembolism and Arterial Thromboembo...mentioning

confidence: 99%

“…Its value in prediction in an immunotherapy-only cohort has not been fully evaluated. Some studies found KS to predict for risk of VTE 18,20,45 whereas others did not. 1,24,26,42,[47][48][49][50][51]…”

Section: Risk Factorsmentioning

confidence: 99%

New drugs, old problems: immune checkpoint inhibitors and cancer-associated thrombosis

Patel,

Khorana

2024

Bleed Thromb Vascul Biol

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A frequent side effect of cancer treatment is venous thromboembolism (VTE), which is made more likely by systemic anticancer medication. Immune checkpoint inhibitors (ICIs) have emerged as a paradigm-shifting treatment for many cancers. Early trials investigating the efficacy of ICIs did not identify thrombosis as a significant adverse event of concern. An initial meta-analysis reported a 1.1% [95% confidence interval (CI) 0.5-2.1] risk of arterial thromboembolism (ATE) and a 2.7% (95% CI 1.8-4.0) rate of vein thrombosis. ICIs have, however, been linked to ATE and VTE in an increasing number of post-marketing investigations. The reported incidence rates of cumulative VTE range from 5-8% at 6 months to 10-12% at 12 months, while the rates of ATE vary from 1-2% at 6 months to 17 months. Furthermore, a number of studies show a correlation between reduced survival and ICI-related thromboembolism. In order to provide a compiled and thorough narrative on the mechanisms, incidence, risk factors, and survival related to ICI-associated VTE and ATE, this narrative review summarizes the literature.

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“…In addition to retrospective cohort studies, three Danish population cohort studies reported the incidence of thrombosis in patients on ICIs ( Table 3 ) [ 43 , 44 , 45 ]. It is interesting to note that the rates of thrombosis appear to be numerically lower in the population studies compared to the above-mentioned retrospective studies, with 6-month VTE rate of 2–4% and 4–7% at 12 months.…”

Section: Incidence Of Thrombosis In Patients Receiving Immune Checkpo...mentioning

confidence: 99%

“…As the development of the Khorana score predated ICIs, whether it can accurately predict thrombosis in patients receiving ICIs remains controversial as studies have shown mixed results. Most studies did not find the Khorana score to carry sufficient predictivity in this population [ 18 , 23 , 29 , 31 , 32 , 33 , 35 , 36 , 37 ], while a few studies did [ 27 , 45 , 46 ].…”

Section: Risk Factors Of Thrombosis In Patients On Immune Checkpoint ...mentioning

confidence: 99%

Immune Checkpoint Inhibitors-Associated Thrombosis: Incidence, Risk Factors and Management

Wang

Carrier

2023

Current Oncology

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Immune checkpoint inhibitors (ICIs) target programmed cell death (PD) 1 receptor and its ligand PD-L1, and have become an integral part of treatment regimens in many cancers including lung cancer, renal cell carcinoma, melanoma, and more. Cancer is associated with a significantly increased risk of venous thromboembolism compared to non-cancer patients, and the risks increase further with anticancer therapies including ICIs. Cancer-associated thrombosis can lead to hospitalizations, delayed cancer treatment, and mortality. While thrombosis was not reported as a major complication in initial clinical trials leading to the approval of ICIs, emerging evidence from post-marketing studies revealed concerning risks of thrombosis in patients receiving ICIs. However, results remained heterogenous given differences in study designs and populations. Recent studies also showed that C-reactive protein dynamics might be an easily accessible biomarker for thrombosis and disease response in this population. In addition, early findings indicated that a commonly used anticoagulant for cancer-associated thrombosis, factor Xa inhibitors, might have potential synergistic antitumor effects when combined with ICIs. Herein we will review the current literature on the incidence, risk factors, and management of thrombosis in patients with cancer receiving ICIs. We aim to provide valuable information for clinicians in managing these patients.

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The Khorana score and venous and arterial thrombosis in patients with cancer treated with immune checkpoint inhibitors: A Danish cohort study

Cited by 11 publications

References 51 publications

Construction and Validation of a Nomogram to Predict the Postoperative Venous Thromboembolism Risk in Patients with HGSOC

Construction and Validation of a Nomogram to Predict the Postoperative Venous Thromboembolism Risk in Patients with HGSOC

New drugs, old problems: immune checkpoint inhibitors and cancer-associated thrombosis

Immune Checkpoint Inhibitors-Associated Thrombosis: Incidence, Risk Factors and Management

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