Venous thrombotic events in patients treated with immune checkpoint inhibitors for non-small cell lung cancer: A retrospective multicentric cohort study

Deschênes‐Simard, Xavier; Richard, Corentin; Galland, Loïck; Blais, Florence; Desîlets, Antoine; Malo, Julie; Cvetkovic, Lena; Belkaïd, Wiam; Elkrief, Arielle; Gagné, Andréanne; Hamel, Marc-André; Orain, Michèle; Joubert, Philippe; Ghiringhelli, François; Routy, Bertrand; Blais, Normand

doi:10.1016/j.thromres.2021.06.018

Cited by 46 publications

(62 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Here, a retrospective analysis of a series of 593 patients with NSCLC receiving ICI were shown to have a cumulative incidence of VTE of 14.8%. 39 Here, VTE did not correlate with overall survival. There was a trend toward diminished progression‐free survival in patients who developed thromboses, but this did not reach statistical significance.…”

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 75%

“…The rates of VTE and ATE in these studies range from ~12% to 25% and 2% to 6%, respectively. 23 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 A retrospective review of 2854 patients receiving ICI therapy demonstrated an absolute risk of VTE of 13.8% at 1 year. 36 The patients in this study had a variety of malignancies, but the majority were diagnosed with non‐small cell lung cancer (NSCLC; 28%) and melanoma (28%).…”

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 99%

See 1 more Smart Citation

Hemostasis and tumor immunity

Cantrell

Palumbo

2022

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

Significant data have accumulated demonstrating a reciprocal relationship between cancer and the hemostatic system whereby cancer promotes life‐threatening hemostatic system dysregulation (e.g., thromboembolism, consumptive coagulopathy), and hemostatic system components directly contribute to cancer pathogenesis. The mechanistic underpinnings of this relationship continue to be defined, but it is becoming increasingly clear that many of these mechanisms involve crosstalk between the hemostatic and immune systems. This is perhaps not surprising given that there is ample evidence for bidirectional crosstalk between the hemostatic and immune systems at multiple levels that likely evolved to coordinate the response to injury, host defense, and tissue repair. Much of the data linking hemostasis and immunity in cancer biology focus on innate immune system components. However, the advent of adaptive immunity‐based cancer therapies such as immune checkpoint inhibitors has revealed that the relationship of hemostasis and immunity in cancer extends to the adaptive immune system. Adaptive immunity‐based cancer therapies appear to be associated with an increased risk of thromboembolic complications, and hemostatic system components appear to regulate adaptive immune functions through diverse mechanisms to affect tumor progression. In this review, the evidence for crosstalk between hemostatic and adaptive immune system components is discussed, and the implications of this relationship in the context of cancer therapy are reviewed. A better understanding of these relationships will likely lead to strategies to make existing adaptive immune based therapies safer by decreasing thromboembolic risk and may also lead to novel targets to improve adaptive immune‐based cancer treatments.

show abstract

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 75%

Section: Adaptive Immune Directed Cancer Therapy and Thromboembolismmentioning

confidence: 99%

Hemostasis and tumor immunity

Cantrell

Palumbo

2022

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…VTE rates were higher among patients with non‐small cell lung cancer treated with platinum‐based chemotherapy than those treated with ICI alone in 345 patients with cancer 31 . Likewise, Deschênes‐Simard et al 32 . found that overall incidence of VTEs was similar in patients receiving ICIs for non‐small cell lung cancer to that observed in patients treated with chemotherapy alone.…”

Section: Discussionmentioning

confidence: 93%

Immune Checkpoint Inhibitors and Venous Thromboembolism: An Analysis of the WHO Pharmacovigilance Database

Allouchery

Beuvon

Pérault‐Pochat

et al. 2022

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

Data on venous thromboembolic events (VTEs) in patients receiving immune checkpoint inhibitors (ICIs) are scarce and conflicting. This study investigated the risk of reporting VTEs associated with ICIs in comparison with all other anticancer drugs. The World Health Organization pharmacovigilance database (VigiBase), comprising >30 million individual case safety reports, was queried. All reports on patients with cancer, involving at least one anticancer drug as a suspect or interacting drug and registered from January 1, 2008, to May 31, 2021, were included. The association between ICIs and the risk of reporting VTEs was estimated using the reporting odds ratio (ROR) as a measure of disproportionality with all other anticancer drugs as comparators. RORs were estimated as crude and adjusted RORs for age, sex, and other medications (excluding anticancer drugs) associated with risk of VTEs. Among 1,196 patients experiencing VTEs after ICI treatment, the median age was 65 years and 57.6% were men. Anti‐PD‐1 agents (62.5%) were the most frequently reported. ICIs were not associated with higher reporting of VTEs when compared with other anticancer drugs (crude ROR 0.63, 95% confidence interval (CI) 0.60 to 0.67 and adjusted ROR 0.70, 95% CI 0.65–0.74). No signal of disproportionate reporting was found when considering each class of ICIs. In conclusion, ICIs were not associated with higher reporting of VTEs, in comparison with all other anticancer drugs in a large‐scale pharmacovigilance database. Owing to the limitations inherent to pharmacovigilance studies, prospective studies, including an adequate comparison group, are needed to assess the risk of VTEs in ICI‐treated patients.

show abstract

“…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.…”

Section: Methodsmentioning

confidence: 99%

“…In patients receiving ICIs, several studies have shown that the occurrence of thrombosis was associated with worsening survival [10,11,[20][21][22] while others have not [14][15][16] (Table 2). Possible explanations of worse survival in patients who developed VTE include that thrombosis is an indicator for more advanced cancer stage, worse prognosis, poorer performance status, and/or thrombosis or anticoagulation-related mortality.…”

Section: Survival and Thrombosis In Patients Receiving Immune Checkpoint Inhibitorsmentioning

confidence: 99%

Thrombotic Complications Associated with Immune Checkpoint Inhibitors

Wang

Khorana

Carrier

2021

Cancers

View full text Add to dashboard Cite

Thromboembolism is a common complication in patients with cancer and is associated with significant morbidity and mortality. Anticancer treatment is a known risk factor of cancer-associated thrombosis. Immune checkpoint inhibitors have become a mainstay of treatment in various cancers. Both venous and arterial thrombosis have been increasingly reported as adverse events associated with immune checkpoint inhibitors in recent studies, with a cumulative incidence of venous thrombosis to be 5–8% at 6 months and over 10% at 12 months. Additionally, rates of approximately 1–5% for arterial thrombosis were reported at 12 months. Data also showed an association of thromboembolism with adverse survival. Many pertinent clinical questions in this population deserve further investigation, including the risks of thrombosis associated with immune checkpoint inhibitors as compared to those with traditional systemic therapy, associated risk factors, and the optimal prevention and treatment strategies. In this review, we synthesize data from available literature, provide relevant information for clinicians and potential future directions for research.

show abstract

Venous thrombotic events in patients treated with immune checkpoint inhibitors for non-small cell lung cancer: A retrospective multicentric cohort study

Cited by 46 publications

References 49 publications

Hemostasis and tumor immunity

Hemostasis and tumor immunity

Immune Checkpoint Inhibitors and Venous Thromboembolism: An Analysis of the WHO Pharmacovigilance Database

Thrombotic Complications Associated with Immune Checkpoint Inhibitors

Contact Info

Product

Resources

About