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Thromboembolism and Immune Checkpoint Blockade in Cancer Patients: An Old Foe for New Research

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Abstract

Patients with cancer are at an increased risk of venous (VTE) and arterial thromboembolism (ATE), and thromboembolic events (TEs) represent the second-leading cause of death in cancer patients. The risk of cancer-associated thromboembolism is multifactorial. In addition to patient risk factors, anticancer treatments have been found to increase the risk of both VTE and ATE. Immune checkpoint blockade (ICB) has become a mainstay of treatment in various types of cancers. Their use is associated with the occurrence of a new spectrum of side effects called immune-related adverse events. Meta-analyses—including data from prospective and retrospective studies—and case reports both reported VTE and ATE as adverse events associated with ICB, with a cumulative incidence equaling around 3% and 1%, respectively. The exact mechanism underlying a TE after ICB use is currently unclear, as well as its associated risk factors. Considering their potential life-threatening impact, it is important for clinicians to be aware of the potential thrombotic complications, to educate patients and recognize early signs and symptoms of VTE and ATE, in order to allow prompt treatment (if needed) and avoid complications.

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Acknowledgments

Authors thank Dr. David Gray for assistance in writing in English.

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Authors and Affiliations

  1. Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 90, rue Meymeersch, 1070, Anderlecht, Belgium

    Mireille Langouo Fontsa

  2. Azienda Ospedaliero Universitaria Policlinico San Marco, Via Santa Sofia, 78, Catania, Italy

    Marco Maria Aiello

  3. Columbia Center for Translational Immunology, Columbia University Medical Center, 650 West 168th St., New York, NY, 10032, USA

    Edoardo Migliori

  4. Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy

    Mario Scartozzi

  5. Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy

    Matteo Lambertini

  6. Molecular Immunology Unit, Institut Jules Bordet, Boulevard de Waterloo, 121, Brussels, Belgium

    Karen Willard-Gallo

  7. Medical Oncology, AOU Cagliari, Policlinico Duilio Casula, Monserrato, Italy

    Cinzia Solinas

  8. Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy

    Matteo Lambertini

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Correspondence to Mireille Langouo Fontsa.

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Conflict of interest

Matteo Lambertini declares the following potential conflict of interest, all outside the submitted work: consultancy or advisory fees: Roche, Lilly, Novartis, AstraZeneca, Pfizer, Seagen, Gilead, MSD, Exact Sciences; speaker honoraria: Roche, Lilly, Novartis, Pfizer, Takeda, Ipsen, Sandoz, Libbs, Knight. Mario Scartozzi acted as consultant for MSD, BMS, Astra‐Zeneca, Merck, Amgen and Servier and received speaker honoraria from MSD, Mercks, Amgen, Eisai, Servier outside the submitted work. Mireille Langouo Fontsa, Marco Maria Aiello, Edoardo Migliori, Karen Willard-Gallo, and Cinzia Solinas declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Mireille Langouo and Cinzia Solinas entirely wrote the manuscript. Mireille Langouo, Marco Aiello and Cinzia Solinas drafted the manuscript, did the bibliographic search and are responsible for data accuracy. Edoardo Migliori and Mireille Langouo created the figure. Marco Aiello, Edoardo Migliori, Matteo Lambertini and Mario Scartozzi gave intellectual input and contributed to the edits of the manuscript. Cinzia Solinas supervised the entire process. All authors read the final version and agreed to final submission.

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Langouo Fontsa, M., Aiello, M.M., Migliori, E. et al. Thromboembolism and Immune Checkpoint Blockade in Cancer Patients: An Old Foe for New Research. Targ Oncol 17, 497–505 (2022). https://doi.org/10.1007/s11523-022-00908-8

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