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Poorer baseline performance status is associated with increased thromboembolism risk in metastatic cancer patients treated with immunotherapy

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Abstract

Purpose

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in cancer patients. However, the association of VTE with immunotherapy remains poorly defined. We therefore evaluated the frequency of VTE in patients receiving immunotherapy and tried to determine predisposing factors.

Methods

A total of 133 adult metastatic cancer patients treated with immunotherapy for any cancer between were included. Baseline demographics, ECOG performance status, type of tumors, and baseline blood count parameters were recorded. Possible predisposing factors were evaluated with univariate and multivariate analyses.

Results

The median age was 60 (interquartile range (IQR) 48–66) years, and the median follow-up was 10.1 (IQR 5.8–18.5) months. Renal cell carcinoma (26.3%) and melanoma (24.1%) were most common diagnoses. Fifteen patients (11.3%) had an episode of VTE. Most of the VTEs were diagnosed as pulmonary emboli (10/15; 67%). Eighty percent (12/15) of these VTE cases were detected incidentally. Patients with a baseline ECOG performance status of 1 or more (29.3% of patients) had a significantly increased risk of venous thrombosis (ECOG ≥1 vs. 0, HR: 3.023, 95% CI: 1.011–9.039, p=0.048). Other factors, including patient age, tumor type, body mass index, baseline thrombocyte, neutrophil, and lactate dehydrogenase levels were not significantly associated with VTE risk.

Conclusions

In this study, we observed VTE development in more than 10% of immunotherapy-treated patients and increased VTE risk in patients with poorer ECOG status. With the asymptomatic nature of VTEs in most cases, a high index of suspicion level for VTE is required in patients treated with immunotherapy.

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Data availability

The data was not reposited in the data repositories.

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Authors and Affiliations

  1. Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey

    Deniz Can Guven, Oktay Halit Aktepe, Hasan Cagri Yildirim, Hakan Taban, Neyran Kertmen, Zafer Arik, Omer Dizdar, Saadettin Kilickap, Sercan Aksoy, Suayib Yalcin & Mustafa Erman

  2. Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Melek Seren Aksun, Taha Koray Sahin & Furkan Ceylan

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  1. Deniz Can Guven
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Contributions

DCG and ME have planned the work. DCG, MSA, TKS, OHA, HCY, HT, FC, NK, ZA, OD, SK, SA, SY, and ME participated in patient care and data collection. All authors, namely DCG, MSA, TKS, OHA, HCY, HT, FC, NK, ZA, OD, SK, SA, SY, and ME, have made significant and substantive contributions to the reporting of the work. All authors have participated in the review of relevant literature, drafting of the manuscript, and review and revisions of the final draft. DCG, MSA, TKS, and ME have analyzed the data and determined the main conclusions. DCG has prepared the first draft of the manuscript. All authors reviewed and participated in the preparation of the revised and final version of the manuscript. DCG and ME are responsible for the overall content as guarantors. All co-authors qualify the criteria for authorship according to Vancouver protocol.

Corresponding author

Correspondence to Deniz Can Guven.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of Hacettepe University.

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Guven, D.C., Aksun, M.S., Sahin, T.K. et al. Poorer baseline performance status is associated with increased thromboembolism risk in metastatic cancer patients treated with immunotherapy. Support Care Cancer 29, 5417–5423 (2021). https://doi.org/10.1007/s00520-021-06139-3

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