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Incidence of venous thromboembolic events in cancer patients receiving immunotherapy: a single-institution experience

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Abstract

Background

Cancer and cancer therapies have been associated with an increased incidence of venous thromboembolic events (VTE). However, the incidence of VTE in patients on immunotherapy has not been well characterized. The aim of this study was to assess the incidence of VTE in cancer patients receiving immunotherapy and ascertain its prognostic utility.

Materials and methods

We conducted a single-institution retrospective study, including all cancer patients treated with anti-Programmed cell Death 1 (PD-1), anti-Programmed cell Death Ligand-1 (PD-L1), anti-Cytotoxic T-Lymphocyte-Associated Protein 4 (CTLA4), a combination of anti-PD-1/anti-PD-L1 and anti-CTLA4 or a combination including any of these drugs with chemotherapy, antiangiogenic agents or both between June 2013 and April 2019 at La Paz University Hospital, Madrid (Spain).

Results

We selected 229 patients. VTE occurred in 16 of 229 patients (7%). VTE occurred more frequently in patients with lung cancer followed by melanoma. Female sex and melanoma were independently associated with an increased risk of VTE. 12 of 16 VTE (75%) were symptomatic. Progressive disease to immunotherapy [HR 31.60 (95% CI 11.44–87.22), p = 0.00], lung cancer [HR 2.55 (95% CI 1.34–4.86), p = 0.00] and melanoma [HR 2.42 (1.20–4.86), p = 0.01] were independently associated with shorter OS. VTE occurrence was not independently associated with shorter OS [HR 1.33 (95% CI 0.63–2.80), p = 0.44].

Conclusions

The incidence of VTE in cancer patients receiving immunotherapy in our study appeared to be similar to the incidence previously reported in other series of cancer patients treated with systemic therapies. VTE occurrence did not correlate with the prognosis. Further and prospective studies are needed to derive definitive conclusions.

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Acknowledgements

This work has not been supported by public grants or financial support. No sources of funding were used to assist in the preparation of this manuscript.

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Authors and Affiliations

  1. Medical Oncology Department, Hospital Universitario La Paz, IdiPAZ, Paseo de la Castellana 261, Madrid, 28046, Spain

    L. Gutierrez-Sainz, V. Martinez-Marin, D. Viñal, D. Martinez-Perez, J. Pedregosa, J. A. Garcia-Cuesta, J. Villamayor, P. Zamora, A. Pinto, A. Redondo, B. Castelo, P. Cruz, O. Higuera, A. Custodio, A. Gallego, D. Sanchez-Cabrero, J. de Castro-Carpeño, E. Espinosa & J. Feliu

  2. Translational Oncology Group, IdiPAZ, Madrid, Spain

    V. Martinez-Marin, P. Zamora, A. Pinto, A. Redondo, B. Castelo, A. Custodio, J. de Castro-Carpeño, E. Espinosa & J. Feliu

  3. Cancer & Thrombosis Section, Spanish Society of Medical Oncology (SEOM), Madrid, Spain

    V. Martinez-Marin

  4. Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    P. Zamora, A. Redondo, B. Castelo, J. de Castro-Carpeño, E. Espinosa & J. Feliu

  5. CIBERONC, Madrid, Spain

    J. de Castro-Carpeño, E. Espinosa & J. Feliu

  6. Cátedra UAM-AMGEN, Madrid, Spain

    A. Redondo, B. Castelo, J. de Castro-Carpeño, E. Espinosa & J. Feliu

Authors
  1. L. Gutierrez-Sainz
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  2. V. Martinez-Marin
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  3. D. Viñal
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  19. J. Feliu
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Contributions

Conceptualization: VM-M and LG-S; data collection: LG-S, DV, DM, JAG-C, JP, and JV; data analysis: LG-S and DV; writing—original draft preparation: LG-S, DV, and VM-M; writing—review and editing: PZ, AP, AR, BC, PC, OH, AC, AG, DS-C, JC-C, EE, and JF; supervision: VM-M.

Corresponding author

Correspondence to L. Gutierrez-Sainz.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of the La Paz University Hospital (code HULP: PI-4176), and was conducted in accordance with ethical standards of the Helsinki Declaration of the World Medical Association.

Informed consent

Local ethical committee approved the use of anonymized historic data for the study and waived informed consent from patients.

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Gutierrez-Sainz, L., Martinez-Marin, V., Viñal, D. et al. Incidence of venous thromboembolic events in cancer patients receiving immunotherapy: a single-institution experience. Clin Transl Oncol 23, 1245–1252 (2021). https://doi.org/10.1007/s12094-020-02515-3

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