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Thromboprophylaxis and the route of administration of chemotherapy in testicular cancer patients in German-speaking countries

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Abstract

Purpose

Due to the excellent cure rates for testicular cancer (TC), focus has shifted towards decreasing therapy-related morbidities. Thrombosis is a frequent complication of cisplatin chemotherapy. Furthermore, the optimal route of administration for chemotherapy is still under debate. The purpose of this study was to assess the patterns of care concerning dosing and duration of thromboprophylaxis currently utilized in TC patients in German-speaking countries as well as the route of chemotherapy administration.

Methods

A standardized questionnaire was sent to all members of the German TC Study Group (GTCSG) and to all the urological university hospitals in Germany. The questionnaire was also sent to the oncologic clinics at those universities where urologists do not administer chemotherapy.

Results

The response rate was 87% (55/63). Prophylactic anticoagulation with low-molecular-weight heparin (LMWH) was administered in 94% of the clinics. The dosing of LMWH was prophylactic (85%), high prophylactic (adjusted to bodyweight) (7%), or risk adapted (9%). After completion of chemotherapy, anticoagulation was continued in 15 clinics (33%) for 2 to 24 weeks, while the remainder stopped the LMWH upon cessation of chemotherapy. Chemotherapy was administered via central venous access in 59%, peripheral IV in 27%, or both in 14% of the clinics.

Conclusions

Most of the institutions performed some form of thromboprophylaxis, although the modes of application varied by institution type and amongst the urologists and oncologists. Prospective studies are needed to evaluate the incidence, date of occurrence, and risk factors of venous thrombosis during TC chemotherapy to provide a recommendation concerning prophylactic anticoagulation.

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Abbreviations

TC:

Testicular germ cell cancer

GTCSG:

German TC Study Group

LWMH:

Low-molecular-weight heparin

BEP:

Bleomycin, etoposide, and cisplatin-based polychemotherapy

VTE:

Venous thromboembolism

References

  1. Robert Koch-Institut H (2016) Bericht zum Krebsgeschehen in Deutschland 2016. Berlin. https://doi.org/10.17886/rkipubl-2016-014

    Article  Google Scholar 

  2. Nigam M, Aschebrook-Kilfoy B, Shikanov S, Eggener S (2015) Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009. World J Urol 33(5):623–631. https://doi.org/10.1007/s00345-014-1361-y

    Article  PubMed  Google Scholar 

  3. Ruf CG, Isbarn H, Wagner W, Fisch M, Matthies C, Dieckmann KP (2014) Changes in epidemiologic features of testicular germ cell cancer: age at diagnosis and relative frequency of seminoma are constantly and significantly increasing. Urol Oncol. https://doi.org/10.1016/j.urolonc.2012.12.002

    Article  PubMed  Google Scholar 

  4. Einhorn LH, Donohue J (1977) Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 87(3):293–298

    Article  PubMed  CAS  Google Scholar 

  5. Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna MP, Nicolai N, Oldenburg J (2015) Guidelines on testicular cancer: 2015 update. Eur Urol 68(6):1054–1068. https://doi.org/10.1016/j.eururo.2015.07.044

    Article  PubMed  Google Scholar 

  6. Fung C, Fossa SD, Milano MT, Sahasrabudhe DM, Peterson DR, Travis LB (2015) Cardiovascular disease mortality after chemotherapy or surgery for testicular nonseminoma: a population-based study. J Clin Oncol 33(28):3105–3115. https://doi.org/10.1200/JCO.2014.60.3654

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. de Haas EC, Zwart N, Meijer C, Nuver J, Boezen HM, Suurmeijer AJ, Hoekstra HJ, van der Steege G, Sleijfer DT, Gietema JA (2008) Variation in bleomycin hydrolase gene is associated with reduced survival after chemotherapy for testicular germ cell cancer. J Clin Oncol 26(11):1817–1823. https://doi.org/10.1200/JCO.2007.14.1606

    Article  PubMed  Google Scholar 

  8. Boer H, Proost JH, Nuver J, Bunskoek S, Gietema JQ, Geubels BM, Altena R, Zwart N, Oosting SF, Vonk JM, Lefrandt JD, Uges DR, Meijer C, de Vries EG, Gietema JA (2015) Long-term exposure to circulating platinum is associated with late effects of treatment in testicular cancer survivors. Ann Oncol 26(11):2305–2310. https://doi.org/10.1093/annonc/mdv369

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Lubberts S, Boer H, Altena R, Meijer C, van Roon AM, Zwart N, Oosting SF, Kamphuisen PW, Nuver J, Smit AJ, Mulder AB, Lefrandt JD, Gietema JA (2016) Vascular fingerprint and vascular damage markers associated with vascular events in testicular cancer patients during and after chemotherapy. Eur J Cancer 63:180–188. https://doi.org/10.1016/j.ejca.2016.05.022

    Article  PubMed  CAS  Google Scholar 

  10. Blom JW, Doggen CJ, Osanto S, Rosendaal FR (2005) Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293(6):715–722. https://doi.org/10.1001/jama.293.6.715

    Article  PubMed  CAS  Google Scholar 

  11. Heidegger I, Porres D, Veek N, Heidenreich A, Pfister D (2017) Predictive factors for developing venous thrombosis during cisplatin-based chemotherapy in testicular cancer. Urol Int 99(1):104–109. https://doi.org/10.1159/000471888

    Article  PubMed  CAS  Google Scholar 

  12. Bezan A, Posch F, Ploner F, Bauernhofer T, Pichler M, Szkandera J, Hutterer GC, Pummer K, Gary T, Samonigg H, Beyer J, Winder T, Hermanns T, Fankhauser CD, Gerger A, Stotz M (2017) Risk stratification for venous thromboembolism in patients with testicular germ cell tumors. PLoS ONE 12(4):e0176283. https://doi.org/10.1371/journal.pone.0176283

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Klok FA, van der Hulle T, den Exter PL, Lankeit M, Huisman MV, Konstantinides S (2014) The post-PE syndrome: a new concept for chronic complications of pulmonary embolism. Blood Rev 28(6):221–226. https://doi.org/10.1016/j.blre.2014.07.003

    Article  PubMed  CAS  Google Scholar 

  14. Pesavento R, Bernardi E, Concolato A, Dalla Valle F, Pagnan A, Prandoni P (2006) Postthrombotic syndrome. Semin Thromb Hemost 32(7):744–751. https://doi.org/10.1055/s-2006-951460

    Article  PubMed  Google Scholar 

  15. Encke A, Haas S, Kopp I (2016) The prophylaxis of venous thromboembolism. Dtsch Arztebl Int 113(31–32):532–538. https://doi.org/10.3238/arztebl.2016.0532

    Article  PubMed  PubMed Central  Google Scholar 

  16. Draugalis JR, Coons SJ, Plaza CM (2008) Best practices for survey research reports: a synopsis for authors and reviewers. Am J Pharm Educ 72(1):11

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gizzi M, Oberic L, Massard C, Poterie A, Gwenael LT, Loriot Y, Albiges L, Baciarello G, Michels J, Bossi A, Blanchard P, Escudier B, Fizazi K (2016) Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours. Eur J Cancer 69:151–157. https://doi.org/10.1016/j.ejca.2016.10.003

    Article  PubMed  CAS  Google Scholar 

  18. Honecker F, Koychev D, Luhmann AD, Langer F, Dieckmann KP, Bokemeyer C, Oechsle K (2013) Venous thromboembolic events in germ cell cancer patients undergoing platinum-based chemotherapy. Onkologie 36(11):663–668. https://doi.org/10.1159/000355652

    Article  PubMed  CAS  Google Scholar 

  19. Piketty AC, Flechon A, Laplanche A, Nouyrigat E, Droz JP, Theodore C, Fizazi K (2005) The risk of thrombo-embolic events is increased in patients with germ-cell tumours and can be predicted by serum lactate dehydrogenase and body surface area. Br J Cancer 93(8):909–914. https://doi.org/10.1038/sj.bjc.6602791

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Riess H, Pelzer U, Hilbig A, Stieler J, Opitz B, Scholten T, Kauschat-Bruning D, Bramlage P, Dorken B, Oettle H (2008) Rationale and design of PROSPECT-CONKO 004: a prospective, randomized trial of simultaneous pancreatic cancer treatment with enoxaparin and chemotherapy). BMC Cancer 8:361. https://doi.org/10.1186/1471-2407-8-361

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Moore RA, Adel N, Riedel E, Bhutani M, Feldman DR, Tabbara NE, Soff G, Parameswaran R, Hassoun H (2011) High incidence of thromboembolic events in patients treated with cisplatin-based chemotherapy: a large retrospective analysis. J Clin Oncol 29(25):3466–3473. https://doi.org/10.1200/JCO.2011.35.5669

    Article  PubMed  CAS  Google Scholar 

  22. Solari L, Kronig M, Ihorst G, Drognitz K, Heinz J, Jilg CA, Schultze-Seemann W, Engelhardt M, Waller CF (2016) High rates of thromboembolic events in patients with germ cell cancer undergoing cisplatin-based polychemotherapy. Urol Int 96(4):399–405. https://doi.org/10.1159/000445126

    Article  PubMed  CAS  Google Scholar 

  23. Phan M, John S, Casanegra AI, Rathbun S, Mansfield A, Stoner JA, Tafur AJ (2014) Primary venous thromboembolism prophylaxis in patients with solid tumors: a meta-analysis. J Thromb Thrombolysis 38(2):241–249. https://doi.org/10.1007/s11239-013-1014-9

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lemmers NW, Gels ME, Sleijfer DT, Plukker JT, van der Graaf WT, de Langen ZJ, Droste JH, Koops HS, Hoekstra HJ (1996) Complications of venous access ports in 132 patients with disseminated testicular cancer treated with polychemotherapy. J Clin Oncol 14(11):2916–2922

    Article  PubMed  CAS  Google Scholar 

  25. Worst T, Sautter L, John A, Weiss C, Hacker A, Heinzelbecker J (2016) Cisplatin-based chemotherapy for testicular germ cell tumors: complication rates of peripheral versus central venous administration. Urol Int 96(2):177–182. https://doi.org/10.1159/000442003

    Article  PubMed  CAS  Google Scholar 

  26. Lee AY, Kamphuisen PW (2012) Epidemiology and prevention of catheter-related thrombosis in patients with cancer. J Thromb Haemost 10(8):1491–1499. https://doi.org/10.1111/j.1538-7836.2012.04817.x

    Article  PubMed  CAS  Google Scholar 

  27. Nayeemuddin M, Pherwani AD, Asquith JR (2013) Imaging and management of complications of central venous catheters. Clin Radiol 68(5):529–544. https://doi.org/10.1016/j.crad.2012.10.013

    Article  PubMed  CAS  Google Scholar 

  28. Yoshida Y, Hoshino S, Aisu N, Naito M, Tanimura S, Mogi A, Tanaka T, Hirata K, Tamura K, Yamashita Y (2015) Administration of chemotherapy via the median cubital vein without implantable central venous access ports: port-free chemotherapy for metastatic colorectal cancer patients. Int J Clin Oncol 20(2):332–337. https://doi.org/10.1007/s10147-014-0703-5

    Article  PubMed  CAS  Google Scholar 

  29. de Wit M, Ortner P, Lipp HP, Sehouli J, Untch M, Ruhnke M, Mayer-Steinacker R, Bokemeyer C, Jordan K (2013) Management of cytotoxic extravasation - ASORS expert opinion for diagnosis, prevention and treatment. Onkologie 36(3):127–135. https://doi.org/10.1159/000348524

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank all participants of the survey. Nature Research Editing Service assisted with manuscript editing.

Funding

This work was supported by the German Ministry of Defence

Author information

Authors and Affiliations

  1. Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany

    Tim Nestler, Hans U. Schmelz & Christian G. Ruf

  2. Department of Urology, University Hospital Dresden, Dresden, Germany

    Johannes Huber

  3. Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, Texas, USA

    Adrienne M. Laury

  4. Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Hendrik Isbarn

  5. Department of Urology, University Hospital Cologne, Cologne, Germany

    Tim Nestler & Axel Heidenreich

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  1. Tim Nestler
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Contributions

T Nestler: project development, data analysis and manuscript writing. J Huber: project development and manuscript editing. A Laury: manuscript editing. H Isbarn: data analysis. A Heidenreich: project development and manuscript editing. H Schmelz: manuscript editing and supervision. C Ruf: project development, manuscript editing and supervision.

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Correspondence to Tim Nestler.

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No research involving human participants or animals was performed.

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For this type of study, formal consent is not required (waived).

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Nestler, T., Huber, J., Laury, A.M. et al. Thromboprophylaxis and the route of administration of chemotherapy in testicular cancer patients in German-speaking countries. World J Urol 36, 913–920 (2018). https://doi.org/10.1007/s00345-018-2222-x

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