Thromboembolic risk in patients with lung cancer receiving systemic therapy

Abstract

Summary In this retrospective study, we investigated the influence of chemotherapy and immunotherapy on thromboembolic risk among United States Veterans with lung cancer during their first 6 months (180 days) following initiation of systemic therapy. Included patients received treatment with common front‐line agents that were divided into four groups: chemotherapy alone, immunotherapy alone, combination of chemo‐ and immunotherapies, and molecularly targeted therapies (control group). The cohort experienced a 7·4% overall incidence of thrombosis, but the analysis demonstrated significantly different rates among the different groups. We explored models incorporating multiple confounding variables as well as the competing risk of death, and these results indicated that both chemo‐ and immunotherapies were associated with an increased incidence of thrombosis, either alone or combined, compared with the control group (7·56%, P = 2.2 × 10–16; 10·2%, P = 2.2 × 10–16; and 7·87%, P = 2.4 × 10–14 respectively vs. 4·10%). The Khorana score was found to be associated with increased risk, as were vascular disease and metastases. We found an association between risk of thrombosis and the use of anticoagulation, accounting for several confounders, including history of thrombosis. Further study is warranted to better determine the drivers of thromboembolic risk and to identify ways to mitigate this risk for patients.

Analysis of thromboembolic events in patients with non-small cell lung cancer who received adjuvant chemotherapy: single-center real-world data

“…Khorana score 22 , previously known to be related to the occurrence of TEEs, was not a risk factor for TEE, mainly because eight (89%) of the patients with TEE had Khorana score of 1. In addition, diabetes mellitus and hypertension did not correlate with the incidence of TEE as previously reported, whereas radiotherapy and history of vascular disease, which are known to be associated with the occurrence of TEEs, were not found to be significant factors 12 , 14 , 19 , 31 , 32 . Although all TEEs occurred in patients with NSCLC of stage IIB or higher, whether a higher stage is a risk factor for the occurrence of TEEs was difficult to determine, considering the absence of statistical significance.…”

Venous thromboembolism incidence and risk factors associated with immune checkpoint inhibitors among patients with advanced non-small cell lung cancer

“…12 Another retrospective population-based cohort study in 95,466 patients with lung cancer who were treated with chemo, ICI, or targeted therapy, or combinations thereof, reported statistically significantly higher rates of VTE in patients treated with ICI alone compared with chemo alone (9.1% vs 6.9%; p<0.02). 6 Patients who received ICI alone were not only most likely to experience a VTE, but also experience an event sooner after the start of treatment compared with patients receiving chemo alone, combined chemotherapies and immunotherapies, or neither of these therapies; this finding was unchanged when death was considered as a competing risk. The study also reported that patients who received prophylactic anticoagulation or aspirin experienced VTE at both a higher rate and a shorter interval than patients who did not.…”

“…Patients with cancer have an increased risk of thrombotic events compared with the general population, with reported incidence rates as high as 20%-30%. [1][2][3][4][5][6] This association has been well established and has critical impacts on morbidity and mortality in patients with cancer. 7 Thromboembolic complications including venous thromboembolism (VTE; ie, pulmonary embolism (PE) and deep vein thrombosis (DVT)) and arterial thromboembolism are the second-most common cause of death in patients with cancer, second only to disease progression.…”

Thrombotic Complications Associated with Immune Checkpoint Inhibitors

“…The references in the relevant articles were also manually searched for related studies. Overall, 18 retrospective studies reporting incidences and/or outcomes of venous and/or arterial thrombosis in patients on ICIs [ 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] and 4 additional relevant systematic reviews and meta-analyses [ 24 , 25 , 26 , 27 ] were identified and included in this review.…”

“…However, as expected, the two cohorts were significantly different in baseline characteristics, including more metastatic disease and much less use as first-line therapy in the ICI cohort, which could have affected the results. Lastly, Madison et al showed that ICIs were associated with a higher risk of thrombosis compared to chemotherapy alone (10.2% vs. 7.6%, respectively) in the univariable analysis, but multivariable analysis failed to show ICI as an independent risk factor for VTE [19], indicating the presence of other confounders. In a report from the FDA Adverse Event Reporting System (FAERS), 1855 patients with ICI-associated thromboembolic events were reported between 2004 and 2019 [42].…”