Venous thromboembolism risk in patients receiving neoadjuvant chemotherapy for bladder cancer

S, Garas; McAlpine, Kristen; Ross, James; Carrier, Marc; Bossé, Dominic; Yachnin, David; Mallick, Ranjeeta; Cagiannos, Ilias; Morash, Chris; Breau, Rodney H.; Lavallée, Luke T.

doi:10.1016/j.urolonc.2022.04.006

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…The current cohort describes risk patterns mainly in patients treated with checkpoint inhibitors in palliative situations, as reflecting contemporary treatment patterns during the study period. Risk patterns in patients treated with checkpoint inhibitors in a curative setting may differ, although risk of venous thromboembolism has been reported to be high also in neoadjuvant settings 50 …”

Section: Discussionmentioning

confidence: 99%

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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

Overvad

Skjøth

Piazza

et al. 2022

Journal of Thrombosis and Haemostasis

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Background:Thrombosis is common among patients with cancer. Primary thromboprophylaxis guided by the Khorana score is endorsed by guidelines but recommendations rely mainly on data from patients treated with chemotherapy.Objectives: To explore if the Khorana score could risk stratify patients with cancer treated with immune checkpoint inhibitors according to risk of venous and arterial thrombosis.Patients/Methods: The study population and Khorana score were defined using administrative Danish health registries. The primary outcome was 6-month risk of venous thromboembolism after initiation of checkpoint inhibitor treatment. Secondary outcomes were arterial thrombosis and any thromboembolic event. Death was considered a competing risk event.Results: Among 3946 patients with cancer initiating checkpoint inhibitor treatment without other indications for anticoagulation, the overall 6-month incidence of venous thromboembolism was 2.6% (95% confidence interval [CI]: 2.1-3.1). Risks were 2.1% (95% CI: 1.5-3.0), 2.6% (95% CI: 2.0-3.4), and 3.7% (95% CI: 2.1-5.9) in low (score 0), intermediate (score 1-2), and high risk (score ≥3) Khorana categories, respectively. Among patients eligible for primary thromboprophylaxis according to guidelines (Khorana score ≥2), risk of venous thromboembolism was 4.1% (95% CI: 3.1-5.4). Higher Khorana risk category was also associated with higher 6-month risk of both arterial thrombosis and any thromboembolic events. Conclusions:The Khorana score was able to risk stratify patients with cancer treated with immune checkpoint inhibitors according to 6-month risk of thromboembolic events. Risks of venous thromboembolism were lower than in randomized thromboprophylaxis trials, thus questioning the absolute benefit of routine primary thromboprophylaxis in an unselected population of patients treated with immune checkpoint inhibitors.

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Section: Discussionmentioning

confidence: 99%

“…Risk patterns in patients treated with checkpoint inhibitors in a curative setting may differ, although risk of venous thromboembolism has been reported to be high also in neoadjuvant settings. 50 …”

Section: Discussionmentioning

confidence: 99%

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

Overvad

Skjøth

Piazza

et al. 2022

Journal of Thrombosis and Haemostasis

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“…However, the specific CTCAE-scoring available for each different type of thromboembolic adverse event was used. No scoring system for the TEE-risk was used, such as the Khorana risk score, with recent findings indicating that a high Khorana score cannot predict TEE-risk in MIBC-patients receiving NAC [ 22 ]. Instead, our strict inclusion criteria allowed for a relatively cohesive patient population.…”

Section: Methodsmentioning

confidence: 99%

Central Venous Access and the Risk for Thromboembolic Events in Patients Undergoing Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

Rydell

Huge

Eriksson

et al. 2022

Life

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Thromboembolic events (TEE) are high-risk complications in patients undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for urothelial muscle-invasive bladder cancer (MIBC). The purpose of the study was to investigate any differences in TEE-incidence, comparing peripherally inserted central catheter (PICC) versus a totally implanted port (PORT) as CVA (central venous access) during NAC. We identified 947 cystectomized MIBC-patients from four Swedish medical centers in 2009–2021. Inclusion criteria were cT2-T4aN0M0 and 375 patients were finally eligible and evaluated, divided into: NAC-administered (n = 283) resp. NAC-naïve-NAC-eligible (n = 92), the latter as tentative control group. Data on TEEs and types of CVA were retrospectively collected and individually validated, from final transurethral resection of the bladder tumor (TUR-B) to 30 days post-RC. Adjusted logistic regression and log rank test were used for statistical analyses. Amongst NAC-administered, 83% (n = 235) received PICCs and 15% (n = 42) PORTs. Preoperative TEEs occurred in 38 PICC-patients (16.2%) and in one PORT-patient (2.4%), with 47 individual events registered. We found a significantly increased odds ratio of TEE in NAC-administered PICC-patients compared to in PORT-patients (OR: 8.140, p-value: 0.042, 95% CI 1.078–61.455). Our findings indicate a greater risk for pre-RC TEEs with PICCs than with PORTs, suggesting favoring the usage of PORTs for MIBC-NAC-patients.

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“…Neoadjuvant chemotherapy was an independent risk factor for VTE in these patients (relative risk [RR] 3.05; 95% CI, 1.16–8.02, p = 0.02). 57 Another retrospective analysis including 6,806 patients with stage I to III colon cancer showed that patients receiving adjuvant chemotherapy had a higher risk of VTE than patients who only had surgery (6 vs. 4%, p < 0.001). 58 Di Nisio et al 59 performed a meta-analysis of 28 cohort studies on patients with cancer who received neoadjuvant chemotherapy.…”

Section: New Risk Factors Of Cancer-associated Thrombosismentioning

confidence: 99%

In Search of the Perfect Thrombosis and Bleeding-Associated Cancer Scale

Wojtukiewicz,

Tesarova,

Karetová

et al. 2023

Semin Thromb Hemost

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Thrombosis and bleeding are commonly observed in cancer patients, and their management is crucial for positive patient outcomes. A comprehensive, prophylactic, and therapeutic management of venous thrombosis should focus on identifying the patients who would benefit most from treatment to reduce mortality and minimize the risk of thrombosis recurrence without significantly increasing the risk of bleeding. Existing cancer scales provide valuable information for assessing the overall burden of cancer and guiding treatment decisions, but their ability to predict thrombotic and bleeding events remains limited. With increasing knowledge of the pathophysiology of cancer and the availability of advanced anticancer therapies, new risk factors for cancer-associated thrombosis and bleeding are being identified. In this report, we analyze the current literature and identify new risk factors for venous thrombosis and bleeding which are not included in routinely used risk scores. While some existing cancer scales partially capture the risk of thrombosis and bleeding, there is a need for more specific and accurate scales tailored to these complications. The development of such scales could improve risk stratification, aid in treatment selection, and enhance patient care. Therefore, further research and development of novel cancer scales focused on thrombosis and bleeding are warranted to optimize patient management and outcomes.

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Venous thromboembolism risk in patients receiving neoadjuvant chemotherapy for bladder cancer

Cited by 5 publications

References 25 publications

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

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

Central Venous Access and the Risk for Thromboembolic Events in Patients Undergoing Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-Invasive Bladder Cancer

In Search of the Perfect Thrombosis and Bleeding-Associated Cancer Scale

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