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Pavlovic D, Niciforovic D, Markovic M, Papic D. Cancer-Associated Thrombosis: Epidemiology, Pathophysiological Mechanisms, Treatment, and Risk Assessment. Clin Med Insights Oncol 2023; 17:11795549231220297. [PMID: 38152726 PMCID: PMC10752082 DOI: 10.1177/11795549231220297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Cancer patients represent a growing population with drastically difficult care and a lowered quality of life, especially due to the heightened risk of vast complications. Thus, it is well established so far that one of the most prominent complications in individuals with cancer is venous thromboembolism. Since there are various improved methods for screening and diagnosing cancer and its complications, the incidence of cancer-associated thrombosis has been on the rise in recent years. Therefore, the high mortality and morbidity rates among these patients are not a surprise. Consequently, there is an excruciating need for understanding the mechanisms behind this complex process, as well as the imperative for adequate analysis and application of the most suitable steps for cancer-associated thrombosis prevention. There are various and numerous mechanisms offering potential answers to cancer-associated thrombosis, some of which have already been elucidated in various preclinical and clinical scenarios, yet further and more elaborate studies are crucial to understanding and preventing this complex and harsh clinical entity. This article elaborates on the growing incidence, mortality, morbidity, and risk factors of cancer-associated thrombosis while emphasizing the pathophysiological mechanisms in the light of various types of cancer in patients and summarizes the most novel therapy and prevention guidelines recommendations.
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Affiliation(s)
- Dragica Pavlovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Danijela Niciforovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marina Markovic
- Center for Internal Oncology, University Clinical Center Kragujevac, Kragujevac, Serbia
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Dragana Papic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Zheng VM, Linn YL, Ch’ng JK, Chng SP. Management of Spontaneous Aortic Thrombus Following Cisplatin-Based Chemotherapy in Urothelial Cancer: A Case Report. Vasc Specialist Int 2023; 39:40. [PMID: 38105728 PMCID: PMC10727851 DOI: 10.5758/vsi.230091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/03/2023] [Accepted: 11/12/2023] [Indexed: 12/19/2023] Open
Abstract
Spontaneous aortic thrombosis is exceedingly rare, and optimal treatment remains uncertain. We present an unusual case of a spontaneous aortic thrombus at the renal artery level in a patient undergoing active cisplatin treatment for urothelial carcinoma. Management included catheter-directed thrombolysis followed by thrombectomy. An open cutdown was performed on the left common femoral artery (CFA), with right groin access via a 6-Fr sheath. Clamping of the left superficial and deep femoral arteries, along with balloon occlusion of the right common iliac artery, prevented distal embolization. A Coda balloon introduced via direct left CFA puncture with a 20-Fr sheath was positioned above the aortic thrombus. After inflation, clots were trawled to the sheath, "sandwiching" the clots before removal of the balloon and sheath via the left groin. Post-operatively, the patient recovered well and received continued therapeutic anticoagulation.
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Affiliation(s)
| | - Yun Le Linn
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Jack Kian Ch’ng
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Siew Ping Chng
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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3
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Wang Z, Li Y, He X, Fu Y, Li Y, Zhou X, Dong Z. In vivo evaluation of the pharmacokinetic interactions between almonertinib and rivaroxaban, almonertinib and apixaban. Front Pharmacol 2023; 14:1263975. [PMID: 37860116 PMCID: PMC10582335 DOI: 10.3389/fphar.2023.1263975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
Background: Almonertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is commonly used as a first-line treatment for non-small cell lung cancer (NSCLC) patients with EGFR T790M mutations. Rivaroxaban and apixaban are a selective, direct factor Xa inhibitor used to treat venous thromboembolism (VTE), which is a frequent complication of NSCLC. Rivaroxaban and apixaban are substrates of CYP3A4, P-gp and BCRP, whereas almonertinib is an inhibitor of P-gp and BCRP. Rivaroxaban or apixaban are often prescribed together with almonertinib in NSCLC patients, but clear information on pharmacokinetic drug interaction is lacking. Therefore, this study aimed to unravel the extent of interactions between almonertinib-rivaroxaban and almonertinib apixaban in rats, and whether the pharmacokinetic interaction can be mitigated by rivaroxaban and apixaban dose adjustment. Methods: Rats were divided into ten groups (n = 6) that received rivaroxaban (2 mg/kg) (group 1), apixaban (0.5 mg/kg) (group 2), almonertinib (15 mg/kg) (group 3, group 4), almonertinib with rivaroxaban (2 mg/kg) (group 5), almonertinib with rivaroxaban (1 mg/kg) (group 6), almonertinib with apixaban (0.5 mg/kg) (group 7), almonertinib with apixaban (0.25 mg/kg) (group 8), rivaroxaban (2 mg/kg) with almonertinib (group 9), apixaban (0.5 mg/kg) with almonertinib (group 10). The concentrations of drugs were determined by an ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS). The levels of messenger RNA were determined using quantitative real-time polymerase chain reaction (qRT-PCR). Results and Discussion: The results indicate that almonertinib increased the Cmax and AUC0-t of 2 mg/kg rivaroxaban by 3.30 and 3.60-fold, 1 mg/kg rivaroxaban by 1.28 and 1.90-fold. Almonertinib increased the Cmax and AUC0-t of 0.5 mg/kg apixaban by 2.69 and 2.87-fold, 0.25 mg/kg apixaban by 2.19 and 2.06-fold. In addition, rivaroxaban also increased systemic exposure to almonertinib. The results of qRT-PCR showed that almonertinib reduced the expression of Cyp3a1 in liver and intestine, and Abcb1a, Abcg2 in intestine and kidney. The pharmacokinetic results suggest that it is important to take special care of the interactions of these drugs in clinical applications.
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Affiliation(s)
- Zhi Wang
- Graduate School of Hebei Medical University, Shijiazhuang, China
| | - Ying Li
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
| | - Xueru He
- Graduate School of Hebei Medical University, Shijiazhuang, China
| | - Yuhao Fu
- Graduate School of Hebei Medical University, Shijiazhuang, China
| | - Yajing Li
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
| | - Xin Zhou
- Graduate School of Hebei Medical University, Shijiazhuang, China
| | - Zhanjun Dong
- Department of Pharmacy, Hebei General Hospital, Shijiazhuang, China
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Türkel A, Özdemir M, Kurtuluş A, Doğan M. Gemcitabine-associated digital necrosis in metastatic breast cancer. J Oncol Pharm Pract 2023; 29:1770-1775. [PMID: 37309162 DOI: 10.1177/10781552231182356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Gemcitabine is a nucleoside analog antimetabolite used in various malignancies, including metastatic breast cancer. Objective response rates in its use as a single agent in the treatment of metastatic breast cancer are not to be underestimated. Cutaneous, hematological, pulmonary, and vascular side effects are well-known side effects. Venous thromboembolism may occur with antineoplastics, such as platinum compounds. Arterial thromboembolism is rare in cancer, almost rare with chemotherapy. Here, we present a metastatic breast cancer patient who had digital necrosis due to arterial occlusion with gemcitabine monotherapy. CASE REPORT A 54-year-old metastatic breast cancer female patient had digital ischemia and necrosis in the left hand's fifth finger after the second course of single-agent gemcitabine as the fourth line setting. Gemcitabine was discontinued, and medical treatment was started. Thrombus was detected in the left subclavian artery digital angiography. Balloon angioplasty and stenting were applied. However, digital amputation had to be performed since tissue necrosis had not regressed despite radiological interventions and medical treatment. MANAGEMENT AND OUTCOME Gemcitabine was discontinued. Low molecular weight heparin and acetylsalicylic acid were started. The distal phalanx was amputated due to necrosis during follow-up. Gemcitabine was permanently stopped. DISCUSSION Gemcitabine-related vascular events, including arterial thrombosis, may also occur in cancer patients, especially those with higher tumor burden. Therefore, predisposing factors for hypercoagulability and vascular occlusion should be questioned in more detail even before starting antineoplastics which are known to have a lower risk for thrombosis, such as gemcitabine monotherapy.
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Affiliation(s)
- Alper Türkel
- Division of Medical Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Mustafa Özdemir
- Department of Radiology, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey
| | - Aziz Kurtuluş
- Division of Medical Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | - Mutlu Doğan
- Division of Medical Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Turkey
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Abdel-Razeq H, Sharaf B, Al-Jaghbeer MJ, Abu-Fares H, Bater R, Shaer MA, Abu-Jaish H, Laban DA, Salamah O, Tamimi F, Ashouri K, Salameh T, Zughul R, Alhalaseh Y. COMPASS-CAT versus Khorana risk assessment model for predicting venous thromboembolic events in patients with non-small cell lung cancer on active treatment with chemotherapy and/or immunotherapy, the CK-RAM study. J Thromb Thrombolysis 2023; 56:447-453. [PMID: 37430158 DOI: 10.1007/s11239-023-02860-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Cancer patients are at higher risk for venous thromboembolism (VTE). Several risk assessment models (RAM), including the Khorana and COMPASS-CAT, were developed to help predict the occurrence of VTE in cancer patients on active anti-cancer therapy. We aim to study the prevalence and predictors of VTE among patients with non-small cell lung cancer (NSCLC) and compare both RAMs in predicting VTE in patients with NSCLC were retrospectively reviewed. Variables known to increase the risk of VTE were collected and risk of VTE was assessed using both Khorana and COMPASS-CAT RAM. A total of 508 patients (mean age ± SD, 58.4 ± 12.2 years) were enrolled. Most (n = 357, 70.3%) patients had adenocarcinoma, and 333 (65.6%) patients had metastatic disease. VTE were confirmed in 76 (15.0%) patients. Rates were higher among patients with metastatic disease (19.8%, p < 0.001), adenocarcinoma (17.4%, p = 0.01) and those treated with immunotherapy (23.5%, p = 0.014). VTE rates were 21.2%, 14.1% and 13.9% among those with high (n = 66), intermediate (n = 341) and low (n = 101) Khorana risk scores, respectively (p = 0.126). On the other hand, 190 (37.4%) were classified as high risk by the COMPASS-CAT RAM; 52 (27.4%) of them had VTE compared to 24 (7.5%) of the remaining 318 (62.6%) classified as Low/Intermediate risk level, p < 0.001. In conclusion, patients with NSCLC are at high risk for VTE, especially those with adenocarcinoma, metastatic disease and when treated with immunotherapy. Compared to Khorana RAM, COMPASS-CAT RAM was better in identifying more patients in high-risk group, with higher VTE rate.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan.
- School of Medicine, The University of Jordan, Queen Rania Al Abdullah Street, P.O. Box: 1269, Amman, 11941, Jordan.
| | - Baha' Sharaf
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Hala Abu-Fares
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rayan Bater
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Moataz Abu Shaer
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hala Abu-Jaish
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Dima Abu Laban
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Osama Salamah
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Faris Tamimi
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Khalid Ashouri
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Tareq Salameh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Raed Zughul
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Yazan Alhalaseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
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Stroke mortality in cancer survivors: A population-based study in Japan. Thromb Res 2023; 222:140-148. [PMID: 36682150 DOI: 10.1016/j.thromres.2023.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/22/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The association between cancer survivors and stroke deaths remains unclear. We aimed to evaluate the risk of fatal stroke in patients with cancer. MATERIALS AND METHODS This study was conducted using data from the Osaka Cancer Registry and vital statistics in Japan, collected from 1985 to 2013. We extracted patient data and investigated the causes of death. Standardized mortality ratios were calculated to compare the risk of stroke in patients with cancer to that in the general population. Poisson regression models were used to estimate the risk of stroke in patients with cancer and other cancer subgroups. Stroke types were used for risk stratification. RESULTS We identified 688,473 eligible patients with cancer. The cohort contributed 2,668,126 person-years at risk. During the study period, 337,117 patients died; stroke was the cause of death in 5496 patients. Stroke types included cerebral infarction (3259), intracerebral hemorrhage (1539), subarachnoid hemorrhage (364), and other cerebrovascular diseases (334). The crude mortality rate from fatal stroke was 205.99 per 100,000 person-years. The standardized mortality ratio (95 % confidence interval) for fatal stroke was 1.75 (1.71-1.80). When stratified by stroke types, the ratios for cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage were 1.83 (1.76-1.89), 2.38 (2.26-2.50), and 2.28 (2.03-2.56), respectively. The risk of fatal stroke increased with time after cancer diagnosis. The multivariate Poisson regression model indicated that men were more likely to die of stroke than women. CONCLUSIONS Cancer survivors have a higher risk of fatal stroke than the general population across all stroke types.
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Rath B, Plangger A, Klameth L, Hochmair M, Ulsperger E, Boeckx B, Neumayer C, Hamilton G. Small cell lung cancer: circulating tumor cell lines and expression of mediators of angiogenesis and coagulation. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:355-365. [PMID: 37205313 PMCID: PMC10185438 DOI: 10.37349/etat.2023.00139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/27/2023] [Indexed: 05/21/2023] Open
Abstract
Aim Coagulation is frequently activated in cancer patients and has been correlated with an unfavorable prognosis. To evaluate whether a putative release of tissue factor (TF) by circulating tumor cells (CTCs) represents a target to impair the dissemination of small cell lung cancer (SCLC), the expression of relevant proteins in a panel of permanent SCLC and SCLC CTC cell lines that have been established at the Medical University of Vienna. Methods Five CTC and SCLC lines were analyzed using a TF enzyme-linked immunosorbent assay (ELISA) tests, RNA sequencing, and western blot arrays covering 55 angiogenic mediators. Furthermore, the influence of topotecan and epirubicin as well as hypoxia-like conditions on the expression of these mediators was investigated. Results The results demonstrate that the SCLC CTC cell lines express no significant amounts of active TF but thrombospondin-1 (TSP-1), urokinase-type plasminogen activator receptor (uPAR), vascular endothelial-derived growth factor (VEGF) and angiopoietin-2 in two cases. The major difference between the SCLC and SCLC CTC cell lines found was the loss of the expression of angiogenin in the blood-derived CTC lines. Topotecan and epirubicin decreased the expression of VEGF, whereas hypoxia-like conditions upregulated VEGF. Conclusions Active TF capable of triggering coagulation seems not to be expressed in SCLC CTC cell lines in significant levels and, thus, CTC-derived TF seems dispensable for dissemination. Nevertheless, all CTC lines form large spheroids, termed tumorospheres, which may become trapped in clots of the microvasculature and extravasate in this supportive microenvironment. The contribution of clotting to the protection and dissemination of CTCs in SCLC may be different from other solid tumors such as breast cancer.
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Affiliation(s)
- Barbara Rath
- Institute of Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Adelina Plangger
- Institute of Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
| | - Lukas Klameth
- Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria
| | - Maximilian Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Hospital Floridsdorf, 1210 Vienna, Austria
| | | | - Bram Boeckx
- Laboratory for Translational Genetics, Department of Human Genetics, University of Leuven, 3580 Leuven, Belgium
| | - Christoph Neumayer
- Department of Vascular Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerhard Hamilton
- Institute of Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: Gerhard Hamilton, Institute of Pharmacology, Medical University of Vienna, Waehringer Street 13A, 1090 Vienna, Austria.
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Bamias A, Tzannis K, Zakopoulou R, Sakellakis M, Dimitriadis J, Papatheodoridi A, Rallidis L, Halvatsiotis P, Tsiara A, Kaparelou M, Kostouros E, Barbarousi D, Koutsoukos K, Fragiadis E, Dellis AE, Anastasiou I, Stravodimos K, Pinitas A, Papatsoris A, Adamakis I, Varkarakis I, Fragoulis C, Pagoni S, Matsouka C, Skolarikos A, Mitropoulos D, Doumas K, Deliveliotis C, Constantinides C, Dimopoulos MA. Risk for Arterial Thromboembolic Events (ATEs) in Patients with Advanced Urinary Tract Cancer (aUTC) Treated with First-Line Chemotherapy: Single-Center, Observational Study. Curr Oncol 2022; 29:6077-6090. [PMID: 36135047 PMCID: PMC9498031 DOI: 10.3390/curroncol29090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Arterial thromboembolism has been associated with cancer or its treatment. Unlike venous thromboembolism, the incidence and risk factors have not been extensively studied. Here, we investigated the incidence of arterial thromboembolic events (ATEs) in an institutional series of advanced urinary tract cancer (aUTC) treated with cytotoxic chemotherapy. The ATE definition included peripheral arterial embolism/thrombosis, ischemic stroke and coronary events. A total of 354 aUTC patients were analyzed. Most patients (95.2%) received platinum-based chemotherapy. A total of 12 patients (3.4%) suffered an ATE within a median time of 3.6 months from the start of chemotherapy. The most frequent ATE was ischemic stroke (n = 7). Two ATEs were fatal. The 6-month and 24-month incidence were 2.1% (95% confidence interval [CI]: 0.9–4.1) and 3.6% (95% CI: 1.9–6.2), respectively. Perioperative chemotherapy increased the risk for ATE by 5.55-fold. Tumors other than UTC and pure non-transitional cell carcinoma histology were also independent risk factors. No association with the type of chemotherapy was found. Overall, ATEs occur in 4.6% of aUTC patients treated with chemotherapy and represent a clinically relevant manifestation. Perioperative chemotherapy significantly increases the risk for ATE. The role of prophylaxis in high-risk groups should be prospectively studied.
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Affiliation(s)
- Aristotelis Bamias
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
- Correspondence: ; Tel.: +30-21-0583-1255; Fax: +30-21-0532-6454
| | - Kimon Tzannis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - Roubini Zakopoulou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Minas Sakellakis
- Hellenic GU Cancer Group, Evrou st 89, 11527 Athens, Attiki, Greece
| | - John Dimitriadis
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Alkistis Papatheodoridi
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Loukianos Rallidis
- 2nd Department of Cardiology, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Panagiotis Halvatsiotis
- 2nd Propaedeutic Dept of Internal Medicine, National & Kapodistrian University of Athens, ATTIKON University Hospital, Rimini st 1, 12642 Chaidari, Attiki, Greece
| | - Anna Tsiara
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Maria Kaparelou
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Efthymios Kostouros
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Despina Barbarousi
- Haematology Division, Alexandra Hospital, Vasilissis Sofias 80, 11528 Athens, Attiki, Greece
| | - Konstantinos Koutsoukos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
| | - Evangelos Fragiadis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Athanasios E. Dellis
- 2nd Dept of Surgery, Aretaieion Academic Hospital, National & Kapodistrian University of Athens, Vas. Sofias Ave 76, 11528 Athens, Attiki, Greece
| | - Ioannis Anastasiou
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Stravodimos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Alexandros Pinitas
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Athanasios Papatsoris
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Ioannis Adamakis
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Ioannis Varkarakis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Charalampos Fragoulis
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Stamatina Pagoni
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charis Matsouka
- Oncology Department, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Andreas Skolarikos
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Dionysios Mitropoulos
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Konstantinos Doumas
- Department of Urology, Athens General Hospital “G. Gennimatas”, Mesogeion 154, 11527 Athens, Attiki, Greece
| | - Charalampos Deliveliotis
- 2nd Dept of Urology, National & Kapodistrian University of Athens, Sismanoglio General Hospital, Sismanoglou st 1, 15126 Athens, Attiki, Greece
| | - Constantinos Constantinides
- 1st Dept of Urology, National & Kapodistrian University of Athens, LAIKON Hospital, Agiou Thoma st 17, 11527 Athens, Attiki, Greece
| | - Meletios-Athanasios Dimopoulos
- Dept of Clinical Therapeutics, National & Kapodistrian University of Athens, ALEXNADRA Hospital, Vas. Sofias Ave 80, 11528 Athens, Attiki, Greece
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Otten LS, Piet B, van den Heuvel MM, Marzolini C, van Geel RMJM, Gulikers JL, Burger DM, Leentjens J, Ter Heine R. Practical recommendations to combine small-molecule inhibitors and direct oral anticoagulants in patients with nonsmall cell lung cancer. Eur Respir Rev 2022; 31:31/164/220004. [PMID: 35705208 DOI: 10.1183/16000617.0004-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The risk for thromboembolisms in nonsmall cell lung cancer (NSCLC) patients is increased and often requires treatment or prophylaxis with direct oral anticoagulants (DOACs). Small-molecule inhibitors (SMIs) to treat NSCLC may cause relevant drug-drug interactions (DDIs) with DOACs. Guidance on how to combine these drugs is lacking, leaving patients at risk of clotting or bleeding. Here, we give practical recommendations to manage these DDIs. METHODS For all DOACs and SMIs approved in Europe and the USA up to December 2021, a literature review was executed and reviews by the US Food and Drug Administration and European Medicines Agency were analysed for information on DDIs. A DDI potency classification for DOACs was composed and brought together with DDI characteristics of each SMI, resulting in recommendations for each combination. RESULTS Half of the combinations result in relevant DDIs, requiring an intervention to prevent ineffective or toxic treatment with DOACs. These actions include dose adjustments, separation of administration or switching between anticoagulant therapies. Combinations of SMIs with edoxaban never cause relevant DDIs, compared to more than half of combinations with other DOACs and even increasing to almost all combinations with rivaroxaban. CONCLUSIONS Combinations of SMIs and DOACs often result in relevant DDIs that can be prevented by adjusting the DOAC dosage, separation of administration or switching between anticoagulants.
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Affiliation(s)
- Leila S Otten
- Dept of Pharmacy and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Berber Piet
- Dept of Pulmonology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Catia Marzolini
- Dept of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Division of Infectious Diseases and Hospital Epidemiology, Depts of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Robin M J M van Geel
- Dept of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Dept of Internal Medicine and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith L Gulikers
- Dept of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Dept of Internal Medicine and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Dept of Pharmacy and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneke Leentjens
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands
| | - Rob Ter Heine
- Dept of Pharmacy and Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Elshoury A, Schaefer JK, Lim MY, Skalla DP, Streiff MB. Update on Guidelines for the Prevention of Cancer-Associated Thrombosis. J Natl Compr Canc Netw 2022; 20:jnccn21298. [PMID: 35728777 DOI: 10.6004/jnccn.2021.7108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/27/2021] [Indexed: 12/24/2022]
Abstract
Patients with cancer are at high risk of developing arterial and venous thromboembolism (VTE). They constitute 15% to 20% of the patients diagnosed with VTE. Depending on the type of tumor, cancer therapy, and presence of other risk factors, 1% to 25% of patients with cancer will develop thrombosis. The decision to start patients with cancer on primary thromboprophylaxis depends on patient preference, balancing risk of bleeding versus risk of thrombosis, cost, and adequate organ function. Currently, guidelines recommend against the use of routine primary thromboprophylaxis in unselected ambulatory patients with cancer. Validated risk assessment models can accurately identify patients at highest risk for cancer-associated thrombosis (CAT). This review summarizes the recently updated NCCN Guidelines for CAT primary prophylaxis, with a primarily focus on VTE prevention. Two main clinical questions that providers commonly encounter will also be addressed: which patients with cancer should receive primary thromboprophylaxis (both surgical and medical oncology patients) and how to safely choose between different anticoagulation agents.
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Affiliation(s)
- Amro Elshoury
- 1Western New York BloodCare (formerly Hemophilia Center of WNY), and.,2University at Buffalo, Buffalo, New York
| | - Jordan K Schaefer
- 3Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ming Y Lim
- 4Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Deidre P Skalla
- 5Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, New York; and
| | - Michael B Streiff
- 6Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Analysis of thromboembolic events in patients with non-small cell lung cancer who received adjuvant chemotherapy: single-center real-world data. Sci Rep 2022; 12:7646. [PMID: 35538092 PMCID: PMC9090734 DOI: 10.1038/s41598-022-11631-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Thromboembolic events (TEEs) are common in cancer patients, with increased risk of TEE by chemotherapy in patients with lung cancer. However, TEEs in patients with non-small cell lung cancer (NSCLC) who received adjuvant chemotherapy have rarely been reported. This study retrospectively analyzed real-world data of 275 patients with NSCLC treated with adjuvant chemotherapy after surgery from October, 2005 to June, 2020, in a single institution. The incidence of TEEs during or within one year of completion of adjuvant chemotherapy was investigated, and factors related to TEEs were analyzed. TEEs were confirmed in nine patients (3.3%), without fatal event related to TEEs. None of the factors, including Khorana score, was significantly associated with the occurrence of TEEs. All patients with TEEs had pathologic stage IIB or higher and a history of smoking, except for one patient. In conclusion, TEEs occurred in a smaller proportion of patients with NSCLC treated with adjuvant chemotherapy in the real world compared with those treated with palliative chemotherapy in previous reports. Furthermore, prophylactic anticoagulation in patients with NSCLC receiving adjuvant chemotherapy may not be needed except for high-risk patients, although those patients should be informed about the possible risk of TEEs.
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12
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Cho H, Choi JH, Kang SY, Lee HW, Choi YW, Kim TH, Ahn MS, Kim CH, Shin YS, Jang JY, Oh YT, Heo J, Sheen SS. Analysis of thromboembolic events in head and neck cancer patients who underwent concurrent chemoradiotherapy with cisplatin. Korean J Intern Med 2022; 37:653-659. [PMID: 35439872 PMCID: PMC9082433 DOI: 10.3904/kjim.2021.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/25/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The study investigated the incidence of thromboembolic events (TEE) in head and neck (H&N) cancer patients who received concurrent chemoradiotherapy (CCRT) with cisplatin, and analyzed the factors affecting TEE occurrence. METHODS Two hundred and fifty-seven patients who started CCRT with cisplatin for H&N cancer from January 2005 to December 2019 were analyzed. RESULTS TEE occurred in five patients, an incidence rate of 1.9%. The 2-, 4-, and 6-month cumulative incidences of TEE were 0.8%, 1.6%, and 1.9%, respectively. Khorana score was the only factor associated with TEE occurrence (p = 0.010). CONCLUSION The incidence of TEE in H&N cancer patients who underwent CCRT with cisplatin was relatively low when compared to other types of cancer. However, patients with a high Khorana score require more careful surveillance for possible TEE occurrence.
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Affiliation(s)
- Hundo Cho
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Seok Yun Kang
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Hyun Woo Lee
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Yong Won Choi
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Tae-Hwan Kim
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon,
Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, Suwon,
Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon,
Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon,
Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon,
Korea
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13
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The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol 2022; 13:654-661. [DOI: 10.1016/j.jgo.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023]
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14
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Clinical impact of cerebral infarction in patients with non-small cell lung cancer. Int J Clin Oncol 2022; 27:863-870. [PMID: 35192084 DOI: 10.1007/s10147-022-02132-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/27/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Lung cancer patients have a high risk of cerebral infarction, but the clinical significance of cerebral infarction in advanced non-small cell lung cancer (NSCLC) remains unclear. This study aimed to comprehensively investigate the incidence, prognostic impact, and risk factors of cerebral infarction in patients with NSCLC. METHODS We retrospectively examined 710 consecutive patients with advanced or post-operative recurrent NSCLC treated between January 2010 and July 2020 at Kumamoto University Hospital. Cerebral infarction was diagnosed according to the detection of high-intensity lesions on diffusion-weighted magnetic resonance imaging regardless of the presence of neurological symptoms during the entire course from 3 months before NSCLC diagnosis. The prognostic impact and risk factors of cerebral infarction were evaluated based on propensity score matching (PSM) and multivariate logistic regression analysis. RESULTS Cerebral infarction occurred in 36 patients (5%). Of them, 21 (58%) and 15 (42%) patients developed asymptomatic and symptomatic cerebral infarction, respectively. PSM analysis for survival showed that cerebral infarction was an independent prognostic factor (hazards ratio: 2.45, 95% confidence interval (CI): 1.24-4.85, P = 0.010). On multivariate logistic regression analysis, D-dimer (odds ratio [OR]: 1.09, 95% CI 1.05-1.14, P < 0.001) and C-reactive protein (OR: 1.10, 95% CI 1.01-1.19, P = 0.023) levels were independent risk factors. CONCLUSION Cerebral infarction occurred in 5% of NSCLC patients, and asymptomatic cerebral infarction was more frequent. Cerebral infarction was a negative prognostic factor and was associated with hyper-coagulation and inflammation. The high frequency of asymptomatic cerebral infarction and its risk in NSCLC patients with these conditions should be recognized.
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15
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Kartolo A, Yeung C, Moffat GT, Hanna L, Hopman W, Baetz T. Venous thromboembolism events in patients with advanced cancer on immune checkpoint inhibitors. Immunotherapy 2021; 14:23-30. [PMID: 34758641 DOI: 10.2217/imt-2021-0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To evaluate the correlation between venous thromboembolism events (VTEs) and immune checkpoint inhibitor (ICI)-based regimens. Methods: This is a retrospective study of 403 patients with advanced cancer on ICI-based regimens. Results: We report 8% VTE incidence post-ICI initiation over a median of 11.1 months of follow-up. Compared with single-agent ICI, dual-ICI was significantly correlated with higher incidence of VTE (odds ratio [OR]: 4.196, 95% CI: 1.527-11.529, p = 0.005), but chemotherapy-immuno-oncology combination was not (OR: 1.374, 95% CI: 0.285-6.632, p = 0.693). Subsequent systemic therapy post-ICI was also independently associated with higher VTE incidence (OR: 2.599, 95% CI: 1.169-5.777, p = 0.019). Conclusion: Our findings suggest potential underreporting of VTE incidence in ICI clinical trials. As dual-ICI is becoming more prevalent in cancer management, clinicians should maintain vigilance regarding VTE in patients with advanced cancer on ICI-based regimens.
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Affiliation(s)
- Adi Kartolo
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Cynthia Yeung
- Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Internal Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gordon T Moffat
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Lilian Hanna
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Wilma Hopman
- Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Tara Baetz
- Cancer Care of Southeastern Ontario, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, Kingston, Ontario, Canada.,Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
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16
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Lee S, Shenoy A, Shi D, Husien M, Serrano PE, Parpia S. Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review. TH OPEN 2021; 5:e461-e469. [PMID: 34604695 PMCID: PMC8483896 DOI: 10.1055/a-1642-4572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/07/2021] [Indexed: 11/14/2022] Open
Abstract
Background
Patients undergoing systemic cancer therapy are susceptible to developing venous thromboembolism (VTE). The most pertinent prognostic factors for VTE remain unclear. This systematic review aims to summarize prognostic factors associated with VTE in this population.
Methods
MEDLINE, Embase, and CENTRAL databases were searched for observational or randomized studies that used multivariable analysis adjusted for tumor type and/or metastatic disease to model the risk of VTE. Adjusted effect estimates for each prognostic factor were collected for all of the included studies. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool.
Results
From 5,988 search results, 15 eligible studies and 42 prognostic factors were identified. A total of 8,554 patients of whom 456 (5.33%) developed VTE were included. Fourteen studies had a high risk of bias and one study had a moderate risk. The most commonly reported prognostic factors include age, gender, tumor site, metastasis, performance status, and systemic therapy type. Poor performance status and the use of platinum-based chemotherapy compounds were associated with an increased risk of VTE across the majority of studies. The evidence to suggest that the other prognostic factors identified were associated with VTE development was inconclusive. Several individual studies identified novel biomarkers for VTE. Heterogeneity in statistical methods and prognostic factor definitions across studies precluded meta-analysis.
Conclusion
Overall, many prognostic factors were identified; however, the evidence for association with development of VTE for most of the factors is inconclusive. Findings were limited by high heterogeneity and risk of bias in the included studies.
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Affiliation(s)
- Sandra Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anika Shenoy
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Daniel Shi
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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17
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Lee S, Shenoy A, Shi D, Husien M, Serrano PE, Parpia S. Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review. TH OPEN 2021. [PMID: 34604695 DOI: 10.1055/s-0041-1736310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background Patients undergoing systemic cancer therapy are susceptible to developing venous thromboembolism (VTE). The most pertinent prognostic factors for VTE remain unclear. This systematic review aims to summarize prognostic factors associated with VTE in this population. Methods MEDLINE, Embase, and CENTRAL databases were searched for observational or randomized studies that used multivariable analysis adjusted for tumor type and/or metastatic disease to model the risk of VTE. Adjusted effect estimates for each prognostic factor were collected for all of the included studies. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Results From 5,988 search results, 15 eligible studies and 42 prognostic factors were identified. A total of 8,554 patients of whom 456 (5.33%) developed VTE were included. Fourteen studies had a high risk of bias and one study had a moderate risk. The most commonly reported prognostic factors include age, gender, tumor site, metastasis, performance status, and systemic therapy type. Poor performance status and the use of platinum-based chemotherapy compounds were associated with an increased risk of VTE across the majority of studies. The evidence to suggest that the other prognostic factors identified were associated with VTE development was inconclusive. Several individual studies identified novel biomarkers for VTE. Heterogeneity in statistical methods and prognostic factor definitions across studies precluded meta-analysis. Conclusion Overall, many prognostic factors were identified; however, the evidence for association with development of VTE for most of the factors is inconclusive. Findings were limited by high heterogeneity and risk of bias in the included studies.
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Affiliation(s)
- Sandra Lee
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anika Shenoy
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Daniel Shi
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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18
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Left Upper Lobectomy for Lung Cancer as a Risk Factor for Cerebral Infarction: A Systematic Review and Meta-Analysis. Lung 2021; 199:535-547. [PMID: 34570282 DOI: 10.1007/s00408-021-00480-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is limited evidence on the role of the type of lobectomy after primary lung cancer with postoperative cerebral infarction (CI). The purpose of this review was to evaluate the role of left upper lobectomy (LUL) in pulmonary vein thrombosis (PVT) and eventual CI. METHODS A search was performed on MEDLINE, Embase, and Web of Science from inception to January 2021. Prospective and retrospective cohort studies investigating the association between types of lobectomies for primary lung cancer with PVT and/or CI were included. Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias. A random-effect model meta-analysis was utilized if significant heterogeneity was observed. RESULTS Twelve studies, including 5266 patients were included. The majority of studies were having a low risk of bias. LUL was associated with higher likelihood of CI (ORfixed 6.27, 95% Confidence Interval (CI) 3.12-12.56; p < 0.00001) and PVT (ORfixed 13.46, 95% CI 5.97-30.33; p < 0.00001) as compared to other lobectomies. Sensitivity analysis showed an independent role of LUL without underlying PVT in CI (ORfixed 2.44, 95% CI 1.25-4.74; p = 0.009). Male and diabetic patients were at a higher risk, while Video-Assisted Thoracoscopic Surgery (VATS) was protective from CI. CONCLUSION The results of this review indicate that LUL after lung cancer is an independent risk factor for developing CI without underlying PVT. In addition, the risk of CI increases significantly when PVT develops after LUL. LUL is also a risk factor for PVT. A more frequent follow-up may be beneficial in lung cancer patients after LUL, especially in those with diabetes or undergoing adjuvant systemic therapy.
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19
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Current Recommendations for the Management of Cancer-Associated Venous Thromboembolism. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2021. [DOI: 10.2478/jce-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cancer-associated thrombosis (CAT) is a major cause of death in oncological patients. The mechanisms of thrombogenesis in cancer patients are not fully established, and it seems to be multifactorial in origin. Also, several risk factors for venous thromboembolism (VTE) are present in these patients such as tumor site, stage, histology of cancer, chemotherapy, surgery, and immobilization. Anticoagulant treatment in CAT is challenging because of high bleeding risk during treatment and recurrence of VTE. Current major guidelines recommend low molecular weight heparins (LMWHs) for early and long-term treatment of VTE in cancer patients. In the past years, direct oral anticoagulants (DOACs) are recommended as potential treatment option for VTE and have recently been proposed as a new option for treating CAT. This manuscript will give a short overview of risk factors involved in the development of CAT and a summary on the recent recommendations and guidelines for treatment of VTE in patients with malignancies, discussing also some special clinical situations (e.g. renal impairment, catheter-related thrombosis, and thrombocytopenia).
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20
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Harnarayan P, Islam S, Naraynsingh V. Arterial Embolism in Malignancy: The Role of Surgery. Ther Clin Risk Manag 2021; 17:635-640. [PMID: 34177265 PMCID: PMC8219304 DOI: 10.2147/tcrm.s308026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Peripheral arterial embolism from malignant disease is uncommon and a rare cause of limb ischemia. In the acute setting, patients can present with severe ischemia of either the upper or lower limb, and urgent surgical intervention is often required to avoid severe debilitation and limb loss. Patients Our case series comprised three patients who presented with upper and lower limb ischemia and were found to have concomitant malignancy. All three patients were female, with a median age of 54.3 years, and none of the patients was on active chemotherapy. One presented with stage IIb uterine carcinoma, one with stage IIIb ovarian carcinoma, and the other with stage IIIb cervical carcinoma. These patients were referred for vascular management, with two being acute and the other acute on chronic. Results Of the three patients, two presented with acute limb ischemia and underwent arterial thrombectomy, one of the upper and the other the lower limb. The third patient, with acute-on-chronic upper limb ischemia, was treated conservatively with intravenous heparin followed by oral anticoagulation. All three had limb salvage and survival outcome at 1 year post-treatment. Conclusion In this small series, surgical intervention in two patients and conservative management in the other patient led to limb salvage with a reasonably good quality of life. Even though the long-term survival for patients with malignant disease is generally poor, surgical intervention can achieve limb salvage with a reasonably good quality of life.
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Affiliation(s)
- Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shariful Islam
- Department of Surgery, San Fernando General & Teaching Hospitals, San Fernando, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, Medical Associates Hospital, St. Joseph, Trinidad and Tobago
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21
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Nishimura T, Sueyoshi E, Tasaki Y, Uetani M. Asymptomatic floating thrombus in the ascending aorta depicted on four-dimensional computed tomography. SAGE Open Med Case Rep 2020; 8:2050313X20971894. [PMID: 33224502 PMCID: PMC7649852 DOI: 10.1177/2050313x20971894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Abstract
Aortic mural thrombi of the ascending aorta are rare. If an aortic mural thrombus is dislodged, it can cause various embolic complications, which can sometimes be fatal. Although contrast-enhanced computed tomography (CT) and transesophageal echography are useful for diagnosing aortic mural thrombi, four-dimensional CT (4D-CT) is one of the most useful modalities for both diagnosis and treatment selection in such cases. 4D-CT can be used to evaluate the morphology and mobility of thrombi. Furthermore, it is minimally invasive. To the best of our knowledge, there have not been any reports about 4D-CT being used to depict an asymptomatic ascending aortic thrombus. We report a very unusual case, involving an aortic mural thrombus of the ascending aorta.
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Affiliation(s)
- Takamasa Nishimura
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuichi Tasaki
- Department of Cardiovascular Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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22
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Khadka S, Byanju R, Poon S. Chemotherapy-Induced Central Retinal Artery Occlusion in Gestational Trophoblastic Neoplasia: Case Report. Int Med Case Rep J 2020; 13:431-435. [PMID: 32982483 PMCID: PMC7501951 DOI: 10.2147/imcrj.s266456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
The use of anticancer chemotherapy (ACC) has resulted in longer patient survival but has also increased drug-related adverse effects. A 22-year-old female receiving cisplatin-based intravenous chemotherapy for high risk variant of gestational trophoblastic neoplasia (GTN) presented with complaints of sudden painless loss of vision in her right eye for a duration of 4 hours. Ocular findings were suggestive of central retinal artery occlusion (CRAO). After exclusion of other potential aetiological risk factors, the patient was diagnosed with CRAO associated with cisplatin. Cancer patients are prone to thromboembolic events (TEE) not only due to primary disease but also due to underlying comorbidities and treatment modalities. The high incidence of TEE in patients under cisplatin therapy mandates a high degree of suspicion among the treating physicians. This rare possibility of irreversible visual toxicity should also be considered among the patients under cisplatin chemotherapy.
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Affiliation(s)
- Simanta Khadka
- Department of Vitreo-Retina, Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal
| | - Raghunandan Byanju
- Department of Vitreo-Retina, Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal
| | - Suchan Poon
- Department of Vitreo-Retina, Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal
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23
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Abstract
Chemotherapy, alone or in association with radiation therapy, has represented the cornerstone of cancer treatment for decades. However, in the last several years, an unprecedented progress in the understanding of cancer biology and the discovery of novel therapeutic targets have led to a paradigm shift in the management of patients with neoplastic diseases. The introduction of tyrosine kinase inhibitors, vascular endothelial growth factor pathway inhibitors, immunomodulatory agents, proteasome inhibitors, immune checkpoint inhibitors, and chimeric antigen receptor T cells, among others, has been associated with prolonged survival in many forms of cancer. A common feature of both chemotherapy and novel cancer treatments is the frequent occurrence of vascular toxicity, mainly mediated by injury to the endothelium. While the mechanisms may vary between agents, the clinical manifestations may overlap and range from hypertension, vasospastic and thrombotic arterial events (myocardial ischemia and infarction, peripheral ischemia, and limb gangrene), venous thromboembolism (deep vein thrombosis and pulmonary embolism) to capillary leak syndrome. Therefore, the effective management of patients with cancer requires a multidisciplinary team approach in which oncologist and cardiovascular medicine specialists work together to prevent, detect, and minimize acute vascular toxicity and long-term consequences of cancer therapy.
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Affiliation(s)
- Umberto Campia
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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24
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Moik F, Ay C, Pabinger I. Risk prediction for cancer-associated thrombosis in ambulatory patients with cancer: past, present and future. Thromb Res 2020; 191 Suppl 1:S3-S11. [DOI: 10.1016/s0049-3848(20)30389-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/14/2019] [Accepted: 12/23/2019] [Indexed: 01/29/2023]
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25
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Affiliation(s)
- Michael A. Biersmith
- Cardio‐Oncology ProgramDivision of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Matthew S. Tong
- Cardio‐Oncology ProgramDivision of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Avirup Guha
- Cardio‐Oncology ProgramDivision of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
- Harrington Heart and Vascular InstituteCase Western Reserve UniversityClevelandOH
| | - Orlando P. Simonetti
- Cardio‐Oncology ProgramDivision of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
| | - Daniel Addison
- Cardio‐Oncology ProgramDivision of Cardiovascular MedicineDepartment of MedicineThe Ohio State UniversityColumbusOH
- Division of Cancer Prevention and ControlDepartment of MedicineCollege of MedicineThe Ohio State UniversityColumbusOH
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Campia U, Moslehi JJ, Amiri-Kordestani L, Barac A, Beckman JA, Chism DD, Cohen P, Groarke JD, Herrmann J, Reilly CM, Weintraub NL. Cardio-Oncology: Vascular and Metabolic Perspectives: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e579-e602. [PMID: 30786722 DOI: 10.1161/cir.0000000000000641] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardio-oncology has organically developed as a new discipline within cardiovascular medicine as a result of the cardiac and vascular adverse sequelae of the major advances in cancer treatment. Patients with cancer and cancer survivors are at increased risk of vascular disease for a number of reasons. First, many new cancer therapies, including several targeted therapies, are associated with vascular and metabolic complications. Second, cancer itself serves as a risk factor for vascular disease, especially by increasing the risk for thromboembolic events. Finally, recent data suggest that common modifiable and genetic risk factors predispose to both malignancies and cardiovascular disease. Vascular complications in patients with cancer represent a new challenge for the clinician and a new frontier for research and investigation. Indeed, vascular sequelae of novel targeted therapies may provide insights into vascular signaling in humans. Clinically, emerging challenges are best addressed by a multidisciplinary approach in which cardiovascular medicine specialists and vascular biologists work closely with oncologists in the care of patients with cancer and cancer survivors. This novel approach realizes the goal of providing superior care through the creation of cardio-oncology consultative services and the training of a new generation of cardiovascular specialists with a broad understanding of cancer treatments.
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Webb K, Prakash V, Kirresh O, Stewart A. A case of aortitis during cisplatin-based chemotherapy for cervical cancer. BJR Case Rep 2019; 5:20180054. [PMID: 31131127 PMCID: PMC6519499 DOI: 10.1259/bjrcr.20180054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
A case of aortitis in a patient undergoing adjuvant cisplatin and topotecan
chemotherapy for cervical cancer following presentation with pyrexia of unknown
origin and raised inflammatory markers is presented. Although many chemotherapy
agents are known to cause small vessel vasculitis and there are several reported
cases of large vessel vasculitis following gemcitabine chemotherapy, there is
only one previously described case of aortitis following cisplatin
administration. This case is presented with corresponding CT and
18F-FDG PET-CT imaging with discussion of the literature regarding
vasculitis and chemotherapy.
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Affiliation(s)
- Katharine Webb
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Vineet Prakash
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | - Othman Kirresh
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
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Ząbczyk M, Królczyk G, Czyżewicz G, Plens K, Prior S, Butenas S, Undas A. Altered fibrin clot properties in advanced lung cancer: strong impact of cigarette smoking. Med Oncol 2019; 36:37. [PMID: 30891644 DOI: 10.1007/s12032-019-1262-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Dense fibrin networks resistant to lysis have been reported in patients at high risk of thromboembolism. Little is known about fibrin clot properties in cancer. We investigated fibrin clot properties and their determinants in patients with inoperable lung cancer. METHODS We enrolled 150 patients with advanced lung cancer prior to therapy and 90 control subjects matched by age, sex, cardiovascular disease, and diabetes. Plasma clot permeability (Ks), turbidimetric analysis of clot formation, clot lysis time (CLT), microparticle-associated tissue factor (MP-TF) activity, thrombin generation, and serum cotinine levels were determined. RESULTS Lung cancer patients, compared with controls, formed at a faster rate (- 8.1% lag phase) denser plasma fibrin networks (- 27.2% Ks) that displayed impaired lysis (+ 26.5% CLT), along with 19.5% higher MP-TF activity and 100% higher peak thrombin generated, also after adjustment for potential confounders. Cotinine levels were associated with fibrin maximum absorbance (r = 0.20, p = 0.016) and Ks (r = - 0.50, p < 0.0001) in cancer patients. On multivariate regression analysis, an increase in cotinine levels was a predictor of low Ks (the lower quartile, < 5.8 × 10-9 cm2; odds ratio = 1.21 per 10 ng/ml, 95% confidence interval 1.02-1.46), but not CLT. CONCLUSION Advanced lung cancer is associated with the prothrombotic plasma clot phenotype largely driven by smoking.
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Affiliation(s)
- Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka Str. 31-202, Kraków, Poland.,Center for Research and Medical Technology, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland
| | - Grzegorz Królczyk
- Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka Str. 31-202, Kraków, Poland.,Oncology Ward, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland
| | - Grzegorz Czyżewicz
- Oncology Ward, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland
| | | | - Shannon Prior
- Department of Biochemistry, University of Vermont, 360 South Park Drive, Colchester, VT, USA
| | - Saulius Butenas
- Department of Biochemistry, University of Vermont, 360 South Park Drive, Colchester, VT, USA
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, 80 Prądnicka Str. 31-202, Kraków, Poland. .,Center for Research and Medical Technology, John Paul II Hospital, Pradnicka 80, 31-202, Kraków, Poland. .,Faculty of Medicine and Health Sciences, Jan Kochanowski University, IX Wiekow Kielc 19A, 25-317, Kielce, Poland.
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Ramos JD, Holt SK, Schade GR, Galsky MD, Wright JL, Gore JL, Yu EY. Chemotherapy regimen is associated with venous thromboembolism risk in patients with urothelial tract cancer. BJU Int 2019; 124:290-296. [PMID: 30667142 DOI: 10.1111/bju.14685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the association of venous thromboembolism (VTE) with different chemotherapy regimens in patients with urothelial tract cancer. PATIENTS AND METHODS We identified patients aged ≥66 years, diagnosed with urothelial tract cancer in the period 1998 to 2011 in the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database. The chemotherapy regimens analysed were gemcitabine/cisplatin (GC), methotrexate/vinblastine/doxorubicin/cisplatin (MVAC), or gemcitabine/carboplatin (CarboG). Propensity scores for treatment regimen based on comorbidities, tumour characteristics, age, and year of diagnosis were calculated. VTE rates within 120 days of chemotherapy initiation were calculated. VTE risk stratified by chemotherapy regimen was modelled using multivariable logistic regression, adjusting for treatment propensity scores and additional demographic characteristics. Overall survival stratified by VTE and chemotherapy regimen was estimated using Kaplan-Meier methods and the log-rank test. RESULTS Of 5594 identified patients, a VTE occurred in 13.0%. The VTE rates within 120 days of chemotherapy initiation were 15.3% for GC, 8.7% for MVAC, and 12.0% for CarboG. On multivariable analysis, MVAC (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.39-0.94) and CarboG (OR 0.71, 95% CI: 0.59-0.85) were associated with lower VTE risk compared with GC. VTE was associated with worse overall survival (P < 0.001). CONCLUSIONS Compared with GC, MVAC and CarboG were associated with a lower rate of VTE. This finding suggests that gemcitabine may add to the increased thrombosis risk from cisplatin. Additionally, patients with a VTE had worse survival outcomes than those without a VTE. Analysis of the risk of blood clots with different chemotherapy regimens in patients with urothelial tract cancer showed that GC was associated with the highest rate. We also found that blood clots were associated with worse patient outcomes.
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Affiliation(s)
- Jorge D Ramos
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | | | | | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Acute Left Internal Carotid Artery and Right Popliteal Artery Occlusion Related to Cisplatin-Gemcitabine Based Chemotherapy. Case Rep Neurol Med 2019; 2018:9281918. [PMID: 30652037 PMCID: PMC6311804 DOI: 10.1155/2018/9281918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives The increased risk of thromboembolic complications with active cancer is well known. We present this case to highlight that chemotherapy may increase the risk of thromboembolic events even further in cancer patients. Methods We report a case of a 64-year-old male with Diffuse Large B-Cell Non-Hodgkin's Lymphoma who presented with left-sided headache and right calf pain two weeks after starting Rituximab/Gemcitabine/Cisplatin/Dexamethasone chemotherapy. Neurological examination was normal, but there was an absent right dorsalis pedis pulse. He subsequently developed left vision loss. CT angiogram of the head and neck revealed occlusion of his left internal carotid artery and poor opacification of the left ophthalmic artery. An angiogram of the right leg further revealed acute occlusion of the popliteal artery. Results The patient underwent intra-arterial Tissue Plasminogen Activator injection to his lower limb and was started on Low Molecular Weight Heparin. His vision gradually recovered with time. His chemotherapy regimen was changed to RICE (Rituximab, Ifosfamide, Carboplatin, Etoposide). Conclusion Based on literature review, there are numerous similar presentations of arterial thromboembolism in patients on Cisplatin-based chemotherapy. A high index of suspicion for such events should be maintained for patients on chemotherapy presenting with unusual symptoms.
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Królczyk G, Ząbczyk M, Czyżewicz G, Plens K, Prior S, Butenas S, Undas A. Altered fibrin clot properties in advanced lung cancer: impact of chemotherapy. J Thorac Dis 2018; 10:6863-6872. [PMID: 30746232 DOI: 10.21037/jtd.2018.11.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Faster formation of dense and poorly lyzable fibrin networks have been reported in patients at risk of thromboembolism, including cancer patients. We sought to investigate whether chemotherapy affects plasma fibrin clot properties and their determinants in lung cancer patients. Methods In this observational study we enrolled 83 consecutive patients with advanced inoperable lung cancer. Plasma fibrin clot permeability (Ks), turbidimetric analysis of clot formation, clot lysis time (CLT), microparticle-associated tissue factor (MP-TF) activity, and thrombin generation parameters were investigated at enrolment and 3-4 months after standard chemotherapy. Results Lung cancer patients after 4 (range, 4-5) cycles of chemotherapy had 35.6% higher D-dimer, 22.1% lower MP-TF activity, and unaltered fibrinogen compared with baseline. Chemotherapy resulted also in 7.5% increased Ks, 8.6% prolonged lag phase, and 5.4% shortened CLT, while thrombin generation was unchanged. Chemotherapy-related differences in clot structure were confirmed by scanning electron microscopy images. Fibrin clot properties after chemotherapy did not differ among histological types of lung cancer, cancer stages or chemotherapy regimens. Interestingly, never smoking (n=13, 16%) was associated with looser post-treatment fibrin structure as reflected by 12.3% higher Ks. Multiple linear regression showed that more advanced cancer stage, higher peak thrombin generation, and higher white blood cell count determined post-treatment change in Ks, while active smoking was associated with change in CLT. Conclusions Three-month chemotherapy in lung cancer patients improves clot properties despite unaffected thrombin generation, suggesting that anticancer treatment might quickly produce antithrombotic actions.
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Affiliation(s)
- Grzegorz Królczyk
- Oncology Ward, John Paul II Hospital, Cracow, Poland.,Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Cracow, Poland
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland
| | | | | | - Shannon Prior
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Saulius Butenas
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland.,Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Cancer-Associated Thrombosis: An Overview of Mechanisms, Risk Factors, and Treatment. Cancers (Basel) 2018; 10:cancers10100380. [PMID: 30314362 PMCID: PMC6209883 DOI: 10.3390/cancers10100380] [Citation(s) in RCA: 322] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 12/15/2022] Open
Abstract
Cancer-associated thrombosis is a major cause of mortality in cancer patients, the most common type being venous thromboembolism (VTE). Several risk factors for developing VTE also coexist with cancer patients, such as chemotherapy and immobilisation, contributing to the increased risk cancer patients have of developing VTE compared with non-cancer patients. Cancer cells are capable of activating the coagulation cascade and other prothrombotic properties of host cells, and many anticancer treatments themselves are being described as additional mechanisms for promoting VTE. This review will give an overview of the main thrombotic complications in cancer patients and outline the risk factors for cancer patients developing cancer-associated thrombosis, focusing on VTE as it is the most common complication observed in cancer patients. The multiple mechanisms involved in cancer-associated thrombosis, including the role of anticancer drugs, and a brief outline of the current treatment for cancer-associated thrombosis will also be discussed.
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Joshi A, Kate S, Noronha V, Patil V, Trivedi V, Goud S, More S, Bhairva S, Prabhash K. Thromboembolic events in patients with advanced stage non-small cell lung cancer treated with platinum-based chemotherapy: a prospective observational study. Ecancermedicalscience 2018; 12:876. [PMID: 30483356 PMCID: PMC6214681 DOI: 10.3332/ecancer.2018.876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Indexed: 12/21/2022] Open
Abstract
Objectives Cancer is frequently complicated by thromboembolic events (TEs). We aimed to determine the incidence of TEs in lung cancer patients treated with platinum-based chemotherapy and study patients’ baseline and treatment attributes correlating with its onset. Materials and methods Advanced lung cancer patients started on platinum-based chemotherapy were evaluated at baseline and during routine visits for the development of TEs. The duration of follow-up was 4 weeks from the last chemotherapy. A TE occurring between the first dose of chemotherapy and 4 weeks after the last dose was considered to be chemotherapy associated. Results Of the 165 patients on platinum chemotherapy who completed follow-up, TEs occurred in 4.8% (8 out of 165) patients. Among these, three patients had developed venous pulmonary thromboembolism and five patients had developed cerebral infarction, out of which four had arterial cerebral infarction and one patient had a superior sagittal sinus thrombosis. The majority of events (7 out of 8) occurred within 100 days of starting platinum chemotherapy. Overall, the median time until occurrence of TE was 48 days (range, 10–130 days). None of the presumed risk factors were found be associated with the occurrence of TEs on univariate analysis. Conclusions Advanced lung cancer patients on platinum chemotherapy are predisposed to thromboembolism due to many factors. Despite its lower incidence in our study, exclusion of patients with prior thrombosis suggests the incidence of de novo thrombosis, and hence raises a valid question of the need of thromboprophylaxis in a selected group of patients.
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Affiliation(s)
- Amit Joshi
- Tata Memorial Hospital, Mumbai 400012, India
| | - Shruti Kate
- Tata Memorial Hospital, Mumbai 400012, India
| | | | - Vijay Patil
- Tata Memorial Hospital, Mumbai 400012, India
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Li Y, Shang Y, Wang W, Ning S, Chen H. Lung Cancer and Pulmonary Embolism: What Is the Relationship? A Review. J Cancer 2018; 9:3046-3057. [PMID: 30210627 PMCID: PMC6134828 DOI: 10.7150/jca.26008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/08/2018] [Indexed: 11/11/2022] Open
Abstract
Pulmonary embolism (PE) is gradually considered to be the third most common disease in the vascular disease category. Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death among males worldwide. Although initially appearing as distinct entities, lung cancer is a great risk factor for the development of PE. Pulmonary embolism is common in lung cancer patients, with a pooled incidence of 3.7%, and unsuspected pulmonary embolism (UPE) is also non-negligible with a rough rate ranging from 29.4% to 63%. Many risk factors of PE have been detected and could be classified into three categories: lung cancer-related, patient-related, and treatment-related factors. Decreased mean survival time could be significantly observed in lung cancer patients with PE or UPE compared to those only, but suspected PE has higher mortality than UPE. Prophylactic anticoagulant therapy benefit might be highest in patients with stage IV non-small cell lung cancer (NSCLC) or limited small cell lung cancer (SCLC), and heparin seems superior to warfarin for thrombotic prophylaxis. Periodically reassessing the risk-benefit ratio of anticoagulant treatment will be an efficient treatment strategy in lung cancer patients with PE.
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Affiliation(s)
- Yupeng Li
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China.,Drs Yupeng Li and Yu Shang contribute equally to this article
| | - Yu Shang
- Department of Respiration, First Hospital of Harbin, Harbin 150081, China.,Drs Yupeng Li and Yu Shang contribute equally to this article
| | - Wenwen Wang
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Hong Chen
- Department of Respiration, Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
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Venous thromboembolic events in patients with lung cancer treated with cisplatin-based versus carboplatin/nedaplatin-based chemotherapy. Anticancer Drugs 2018; 29:560-564. [DOI: 10.1097/cad.0000000000000625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Dou F, Li H, Zhu M, Liang L, Zhang Y, Yi J, Zhang Y. Association between oncogenic status and risk of venous thromboembolism in patients with non-small cell lung cancer. Respir Res 2018; 19:88. [PMID: 29743116 PMCID: PMC5944093 DOI: 10.1186/s12931-018-0791-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 01/06/2023] Open
Abstract
Background Preclinical data suggest that oncogene (EGFR and KRAS) events regulate tumor procoagulant activity. However, few studies have prospectively investigated the clinical relevance between the presence of EGFR or KRAS mutations and occurrence of venous thromboembolism(VTE) in patients with non-small cell lung cancer (NSCLC). Methods A total of 605 Chinese patients with newly diagnosed NSCLC were included and were followed for a maximum period of 4.5 years. EGFR and KRAS mutations were determined by amplification refractory mutation system polymerase chain reaction method at inclusion. The main outcome was objectively confirmed VTE. Results Of the 605 patients, 40.3% (244) had EGFR mutations and 10.2% (62) of patients had KRAS mutations. In multivariable analysis including age, sex, tumor histology, tumor stage, performance status, EGFR and KRAS status, EGFR wild-type (sub-distribution hazard ratio 1.81, 95% confidence interval 1.07–3.07) were associated with the increased risk of VTE. In competing risk analysis, the probability of developing VTE was 8.3% in those with and 13.2% in those without EGFR mutations after 1 year; after 2 years, the corresponding risks were 9.7 and 15.5% (Gray test P = 0.047). Conclusions EGFR mutations have a negative association with the risk of VTE in Chinese patients with NSCLC.
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Affiliation(s)
- Feifei Dou
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, 100020, China
| | - Huiqiao Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, 100020, China
| | - Min Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, 100020, China
| | - Lirong Liang
- Department of Clinical Epidemiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yuan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, 100020, China
| | - Jiawen Yi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, 100020, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, 100020, China.
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Evaluation of risk factors and assessment models for predicting venous thromboembolism in lung cancer patients. Med Oncol 2018; 35:63. [PMID: 29616356 PMCID: PMC5882764 DOI: 10.1007/s12032-018-1120-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023]
Abstract
The aim of the study was to investigate the prognostic significance of selected risk assessment models (RAMs) for predicting venous thromboembolism (VTE) events in patients undergoing outpatient chemotherapy for lung cancer. We evaluated the following VTE-risk assessment tools: Khorana risk score (KRS), PROTECHT score, CONKO score and COMPASS-cancer-associated thrombosis score (COMPASS-CAT). Retrospective analyses were performed on 118 patients with lung cancer, 20 of whom developed VTE with a median of 2.5 months from diagnosis. Patients receiving gemcitabine-based regimen (25%), patients with a history of atrial fibrillation (AF) and patients with chronic kidney disease developed VTE more often than other patients. In the multivariate analysis, high COMPASS-CAT score (OR 8.73; 95% CI 1.01–75.22, P = 0.049), gemcitabine chemotherapy (OR 3.37; 95% CI 1.09–10.39, P = 0.035) and AF (OR 7.19; 95% CI 1.89–27.33, P = 0.004) were all significantly associated with VTE development. VTE occurred in; 13% (n = 2) of the KRS high-risk group, 17.7% (n = 11) of the PROTECHT high-risk group, 15% (n = 4) of the CONKO high-risk group and 23.8% (n = 20) of the COMPASS-CAT high-risk group (n = 84). Only the COMPASS-CAT score was able to identify 100% of patients who developed VTE, and best discriminated between patients with high and low risk of VTE development (C statistic 0.89). The ROC analysis indicated a cutoff value of 11 points (95% CI 0.821–0.962) for COMPASS-CAT for VTE development in patients with lung cancer. In conclusion, in our study of all the VTE–RAMs analyzed, the COMPASS-CAT model was the most accurate predictor of VTE development in patients with lung cancer.
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Zugazagoitia J, Biosca M, Oliveira J, Olmedo ME, Dómine M, Nadal E, Ruffinelli JC, Muñoz N, Luna AM, Hernández B, Martínez M, Gallego I, Martínez de Castro E, Font C, Calvo V, Martínez-Marín V, Corral J, Noguerón E, Mondéjar R, García Escobar I, Salvador-Coloma C, Juan Ó, Sánchez Cánovas M, Valdivia J, Ochoa MP, López Castro R, Obispo B, Pangua C, Sereno M, Fernández Franco L, Mielgo X, Calzas J, Blasco A, Aparisi F, Chara L, Grau JF, Soares M, Gómez A, Zenzola V, García-Morillo M, Cacho D, Díaz-Serrano A, Aguado C, Ponce-Aix S, González-Larriba JL, Muñoz AJ, Lora D, Paz-Ares L, Manzano A. Incidence, predictors and prognostic significance of thromboembolic disease in patients with advanced ALK-rearranged non-small cell lung cancer. Eur Respir J 2018; 51:13993003.02431-2017. [DOI: 10.1183/13993003.02431-2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/24/2018] [Indexed: 12/21/2022]
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40
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Cacho-Díaz B, Lorenzana-Mendoza NA, Spínola-Maroño H, Reyes-Soto G, Cantú-Brito C. Comorbidities, Clinical Features, and Prognostic Implications of Cancer Patients with Cerebrovascular Disease. J Stroke Cerebrovasc Dis 2018; 27:365-371. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 12/12/2022] Open
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Tiseo M, Bersanelli M, Barili MP, Bartolotti M, De Luca G, Gelsomino F, Camisa R, Cademartiri F, Ardizzoni A. Asymptomatic Pulmonary Embolism in Lung Cancer: Prevalence and Analysis of Clinical and Radiological Characteristics in 141 Outpatients. TUMORI JOURNAL 2018; 98:594-600. [DOI: 10.1177/030089161209800509] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background The incidence of asymptomatic pulmonary embolism in cancer patients is unknown and strictly related to the imaging used for tumor assessment. Recent findings suggest a similar clinical outcome of asymptomatic pulmonary embolism events compared to symptomatic events with a significant impact on survival. The aim of the present study was to determine the prevalence of asymptomatic pulmonary embolism in a population of lung cancer outpatients and to investigate its clinical features. Methods Outpatients with a diagnosis of lung carcinoma undergoing chemotherapy were selected from October 2006 to June 2009. Disease and patient characteristics, risk factors and treatment modalities were collected. All the computed tomography images performed for each patient during the study period were retrospectively reviewed to identify pulmonary embolism. Results A total of 141 consecutive patients were included and 657 computed tomography scans were completely reviewed (from two to six consecutive scans for each patient). Asymptomatic pulmonary embolism in the study population had a prevalence of 14.9% (21 patients). Most of the events occurred in patients with adenocarcinoma, advanced stage and poor performance status, during the early phases of first-line chemotherapy or at the same time of the cancer diagnosis. Compared with the symptomatic pulmonary embolism events (5 patients), asymptomatic events occurred earlier (time from cancer diagnosis to pulmonary embolism of 3.5 [95% CI, 2.0–4.9] versus 12.1 months [95% CI, 6.3–17.9; P = 0.02]) and had a better prognosis (survival from PE of 7.5 [95% CI, 3.4–11.6] versus 1.9 months [95% CI, 0–3.9; P = 0.04]). Conclusions Our findings indicate an underestimation of embolic events among lung cancer outpatients due to their frequent asymptomatic natur. Such a high prevalence suggests the importance to pay more attention to pulmonary embolism prevention in this population.
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Affiliation(s)
- Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | | | - Marco Bartolotti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giovanni De Luca
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Roberta Camisa
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Andrea Ardizzoni
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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Ay C, Pabinger I. Risk of venous thromboembolism and primary prophylaxis in cancer. Hamostaseologie 2017; 32:132-7. [DOI: 10.5482/ha-1173] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 01/28/2023] Open
Abstract
SummaryVenous thromboembolism (VTE) is a common complication in patients with cancer that causes significant morbidity and mortality. Several patient-, tumour-and treatment-related risk factors for VTE in cancer patients have been identified. An effective and safe thromboprophylaxis in cancer patients at high risk of VTE is desirable. Recently, the identification of potential biomarkers and the development of risk scoring models for prediction of cancer-associated VTE have been published. Whether primary VTE prophylaxis based on risk assessment through these biomarkers and risk prediction models might be useful, is currently not yet known. However, thromboprophylaxis is clearly indicated in high-risk situations. While VTE prophylaxis is recommended in cancer patients undergoing surgery and in hospitalised patients with acute disease, studies in ambulatory cancer patients are still rare and evidence for primary VTE prophylaxis is currently limited. In this review, risk factors associated with VTE in cancer patients and current approaches of thromboprophylaxis in different settings, specifically in ambulatory cancer patients are subjected to a critical evaluation.
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Kim ES, Baran AM, Mondo EL, Rodgers TD, Nielsen GC, Dougherty DW, Pandya KJ, Rich DQ, van Wijngaarden E. Risk of thromboembolism in cisplatin versus carboplatin-treated patients with lung cancer. PLoS One 2017; 12:e0189410. [PMID: 29228042 PMCID: PMC5724847 DOI: 10.1371/journal.pone.0189410] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 11/25/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Carboplatin is widely used to treat lung cancer in the United States as an alternative to cisplatin. Several studies have demonstrated that cisplatin-based regimen is associated with a high frequency of thromboembolic complications. However, there has been limited investigation directly comparing the risk of thromboembolic events (TEEs) between cisplatin- and carboplatin-treated patients with lung cancer. METHODS All lung cancer patients treated with cisplatin or carboplatin at Wilmot Cancer Center, University of Rochester between 2011 and 2014 were included. Patient characteristics including exposure (cisplatin vs. carboplatin) and outcome (TEEs between the time of the first dose of cisplatin or carboplatin and 4 weeks after the last dose) were collected by reviewing electronic medical records. A Fisher's exact test was used to compare the proportion of incident TEEs between cisplatin and carboplatin groups. The risk of TEE associated with carboplatin compared to cisplatin was assessed using multiple logistic regression. RESULTS Among 415 subjects, 317 patients (76.4%) received carboplatin and 98 (23.6%) patients received cisplatin. In the carboplatin group, 10.9% (33/302) of evaluable patients developed treatment-related TEEs vs. 14.7% (14/95) in the cisplatin group. There was no significant difference in the risk of developing TEEs between the two groups (P = 0.32). However, 15.2% of carboplatin-related TEEs were arterial thromboses compared to none in the cisplatin group. CONCLUSIONS The incidence of carboplatin-related TEEs was high in lung cancer patients without significant difference in the risk of developing TEEs between cisplatin and carboplatin groups. Potential use of prophylactic anticoagulation in all platinum-treated patients should be further investigated.
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Affiliation(s)
- Eric S Kim
- Departments of Medicine / James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, United States of America
| | - Andrea M Baran
- Biostatistics and Computational Biology, University of Rochester, Rochester, New York, United States of America
| | - Esther L Mondo
- Departments of Medicine / James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, United States of America
| | - Thomas D Rodgers
- Departments of Medicine / James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, United States of America
| | - Gradon C Nielsen
- Departments of Medicine / James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, United States of America
| | - David W Dougherty
- Departments of Medicine / James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, United States of America
| | - Kishan J Pandya
- Departments of Medicine / James P. Wilmot Cancer Center, University of Rochester, Rochester, New York, United States of America
| | - David Q Rich
- Department of Public Health Science, University of Rochester, Rochester, New York, United States of America
| | - Edwin van Wijngaarden
- Department of Public Health Science, University of Rochester, Rochester, New York, United States of America
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Legius B, Nackaerts K. Severe intestinal ischemia during chemotherapy for small cell lung cancer. Lung Cancer Manag 2017; 6:87-91. [PMID: 30643574 DOI: 10.2217/lmt-2017-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023] Open
Abstract
Thromboembolic events (TEEs) are frequent in cancer patients, especially venous thrombosis. Arterial thrombosis is less frequent. Chemotherapy increases the risk of these TEEs. Although TEEs are often reported, intestinal ischemia is a rare complication in cancer patients treated with chemotherapy. Here we describe a rare case of a patient with small cell lung cancer, who developed intestinal ischemia during treatment with cisplatin-etoposide chemotherapy. Shock and multiple organ failure developed and an urgent laparotomy with total colectomy was necessary. This case and review of the literature show that overall arterial TEEs are not as infrequent and may rarely manifest as intestinal ischemia. A cardiovascular assessment before the start of anticancer therapy is therefore imperative for cancer patients.
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Affiliation(s)
- Barbara Legius
- Department of Pulmonology, Respiratory Oncology Unit, University Hospitals Leuven, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Pulmonology, Respiratory Oncology Unit, University Hospitals Leuven, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
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45
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Fuentes HE, Paz LH, Wang Y, Oramas DM, Simons CR, Tafur AJ. Performance of Current Thromboembolism Risk Assessment Tools in Patients With Gastric Cancer and Validity After First Treatment. Clin Appl Thromb Hemost 2017; 24:790-796. [PMID: 28884610 DOI: 10.1177/1076029617726599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with gastric cancer (GC) are at higher risk of thromboembolism when compared to other solid tumors. We aim to determine the predictive performance of current venous thromboembolism (VTE) predictive tools and their variability and validity after first treatment. Single institution cohort of GC-treated patients (2010*15). We abstracted predictive tools, validated for VTE prediction in patient with cancer; including the Khorana Score (KRS), platelet to lymphocyte ratio (PLR), and neutrophil to lymphocyte ratio (NLR). The primary outcome was CAT prediction. We included 112 patients who were predominantly men (66%), 58 (51-64)-year-olds, with adenocarcinoma (84%) and advanced disease (59%). The median follow-up was 21.3 months (9.5-42.6). The VTE occurrence was 12%. The median time from diagnosis to VTE occurrence was 59 days (36-258). In our cohort, performance status (PS; hazard ratio [HR], 8.02; 95% confidence interval [CI], 2.37-27.14; P < .01) was an independent predictor of VTE whereas KRS (univariate HR, 2.3; 95% CI, 0.7-7.4; P = .17), PLR (univariate HR, 0.8; 95% CI, 0.2-3.1; P = .8), and NLR (univariate HR, 0.8; 95% CI, 0.3-2.5; P = .8) at baseline were not associated with VTE risk. The posttreatment KRS was an independent predictor of VTE (HR, 3.69; 95% CI, 1.17-11.65; P = .25) along with PS (HR, 7.58; 95% CI, 2.27-25.33; P = .01). Posttreatment KRS appears as a valid tool to identify patients with GC at high risk of VTE after first cancer treatment.
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Affiliation(s)
- Harry E Fuentes
- 1 Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - L H Paz
- 1 Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Y Wang
- 1 Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - D M Oramas
- 2 Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA
| | - C R Simons
- 1 Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - A J Tafur
- 3 Cardiology-Vascular Medicine, Northshore University Healthsystem, Evanston, IL, USA
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46
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Bagrodia A, Sukhu R, Winer AG, Levy E, Vacchio M, Lee B, Pietzak EJ, Donahue TF, Cha E, Iyer G, Sjoberg DD, Vickers AJ, Rosenberg JE, Bajorin DF, Dalbagni G, Bochner BH. Incidence and Effect of Thromboembolic Events in Radical Cystectomy Patients Undergoing Preoperative Chemotherapy for Muscle-invasive Bladder Cancer. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30232-X. [PMID: 28866245 PMCID: PMC6053335 DOI: 10.1016/j.clgc.2017.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We evaluated the incidence and effect of thromboembolic events (TEEs) in patients with muscle-invasive bladder cancer treated with preoperative chemotherapy (POC) and radical cystectomy (RC) with pelvic lymph node dissection (PLND). PATIENTS AND METHODS We performed a retrospective review of all patients who had undergone POC followed by RC plus PLND for muscle-invasive bladder cancer from June 2000 to January 2013 (n = 357). The chemotherapy type (neoadjuvant vs. induction), incidence and timing of TEE diagnosis (preoperatively vs. ≤ 90 days postoperatively), and effect of TEEs on clinical outcomes were recorded. RESULTS Overall, 79 patients (22%; 95% confidence interval [CI], 18%-27%) experienced a TEE: 57 (16%) occurred during POC and 22 (6.2%) were diagnosed postoperatively. Forty patients (11%; 95% CI, 8.1%-15%) required an inferior vena cava filter. We found no significant differences in neoadjuvant versus induction chemotherapy and the risk of TEEs (difference, 3.3%; 95% CI, -5% to 12%; P = .5). No significant difference were found in the rates of POC completion according to the presence of a TEE (difference, 1.0%; 95% CI, -11% to 13%; P = .9). The occurrence of TEE did not significantly affect other perioperative outcomes. The risk of recurrence and overall survival were not associated with TEE on multivariable analysis. CONCLUSION We found a high incidence of TEEs (22%) in patients undergoing POC before RC plus PLND, with a 16% incidence in the preoperative period. TEEs in the POC setting leads to invasive procedures; however, we did not find a significant effect on POC completion or postoperative complication risk. Further research is required to determine whether preventative TEE measures during POC can improve clinical outcomes.
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Affiliation(s)
- Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
| | - Ranjit Sukhu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew G Winer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Levy
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Vacchio
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Byron Lee
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene J Pietzak
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy F Donahue
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene Cha
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gopa Iyer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dean F Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Guido Dalbagni
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard H Bochner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Marin-Acevedo JA, Koop AH, Diaz-Gomez JL, Guru PK. Non-atherosclerotic aortic mural thrombus: a rare source of embolism. BMJ Case Rep 2017; 2017:bcr-2017-220592. [PMID: 28765187 DOI: 10.1136/bcr-2017-220592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 54-year-old man presented to the emergency department with acute left-sided chest pain and left upper quadrant abdominal pain. He had a significant history of squamous cell carcinoma of the lung previously treated with right pneumonectomy who ; is currently receiving adjuvant chemotherapy with cisplatin. Physical examination was remarkable for tachycardia, hypertension and mild abdominal tenderness. CT angiography revealed an aortic mural thrombus in the ascending aorta and aortic arch without dissection, aneurysm or tortuosity of the aorta. In addition, an infarction of the inferior spleen was reported. Given the high risk of surgery for this patient, he was treated conservatively with esmolol and heparin infusion. His subsequent hospital course was uneventful, and he was successfully discharged on enoxaparin therapy that was successively bridged to rivaroxaban treatment. Follow-up transesophageal echocardiography and CT angiography at one month showed no thrombus in the aorta.
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Affiliation(s)
| | - Andree H Koop
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Riedl JM, Posch F, Bezan A, Szkandera J, Smolle MA, Winder T, Rossmann CH, Schaberl-Moser R, Pichler M, Stotz M, Stöger H, Gerger A. Patterns of venous thromboembolism risk in patients with localized colorectal cancer undergoing adjuvant chemotherapy or active surveillance: an observational cohort study. BMC Cancer 2017; 17:415. [PMID: 28619086 PMCID: PMC5471923 DOI: 10.1186/s12885-017-3392-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/26/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Venous thromoboembolism (VTE) is a frequent and burdensome complication of metastatic colorectal cancer (CRC). However, the epidemiology of VTE in patients with localized CRC after surgery in curative intent is incompletely understood. In this single-center observational cohort study, we investigate patterns of VTE risk in localized CRC, and define its relationship with baseline risk factors, adjuvant chemotherapy and CRC recurrence. METHODS Five-hundred-sixteen patients with stage II/III CRC were included retrospectively at the time of surgery, and followed until the occurrence of VTE, CRC recurrence, or death (median age = 65.1 years, stage II and III: n = 151 (29.5%), n = 361 (70.5%); adjCTX: n = 339 (65.7%)). RESULTS During a median follow-up of 2.7 years, 15 VTEs (2.7%) and 116 recurrences (22.5%) occurred, and 46 patients (8.9%) died. Six-month, 1-year, and 5-year VTE risks were 1.6%, 2.0% and 3.2%, respectively. In competing risk time-to-VTE regression, adjCTX was not associated with an increased risk of VTE (Subdistribution hazard ratio = 0.98, 95% CI:0.33-2.88, p = 0.97). The occurrence of disease recurrence strongly increased the risk of VTE (Multi-state model: Transition hazard ratio (THR) = 13.03, 95% CI:4.39-38.74, p < 0.0001)). Conversely, the onset of VTE did not predict for recurrence (THR = 1.95, 95% CI: 0.62-6.16, p = 0.25). CONCLUSION VTE risk is very low in localized CRC and does not appear to be increased by adjuvant chemotherapy. Thus, primary thromboprophylaxis is unlikely to result in clinical benefit in this population. The strongest determinant of VTE risk appears to be disease recurrence.
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Affiliation(s)
- Jakob Michael Riedl
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Florian Posch
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Angelika Bezan
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Joanna Szkandera
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Maria Anna Smolle
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010, Graz, Austria
| | - Thomas Winder
- Department of internal medicine II, LKH Feldkirch, Carinagasse 47, A-6807, Feldkirch, Austria
| | - Christopher H Rossmann
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Renate Schaberl-Moser
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Department of experimental therapeutics, The University of Texas MD Anderson Cancer Center, 1901 Eastroad, Houston, TX, 77054, USA
| | - Michael Stotz
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Herbert Stöger
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Armin Gerger
- Division of Clinical Oncology; Department of Medicine; Comprehensive Cancer Center Graz, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.,Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010, Graz, Austria
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49
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Procoagulant effects of lung cancer chemotherapy: impact on microparticles and cell-free DNA. Blood Coagul Fibrinolysis 2017; 28:72-82. [PMID: 26919453 DOI: 10.1097/mbc.0000000000000546] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the second leading type of cancer, with venous thromboembolism being the second leading cause of death. Studies have shown increased levels of microparticles and cell-free DNA (CFDNA) in cancer patients, which can activate coagulation through extrinsic and intrinsic pathways, respectively. However, the impact of lung cancer chemotherapy on microparticle and/or CFDNA generation is not completely understood. The aim of the study was to study the effects of platinum-based chemotherapeutic agents on generation of procoagulant microparticles and CFDNA in vitro and in vivo. Microparticles were isolated from chemotherapy-treated monocytes, human umbilical vein endothelial cells, or cancer cells. Tissue factor (TF) and phosphatidylserine levels were characterized and thrombin/factor Xa generation assays were used to determine microparticle procoagulant activity. CFDNA levels were isolated from cell supernatants and plasma. A murine xenograft model of human lung carcinoma was used to study the procoagulant effects of TF microparticles and CFDNA in vivo. In vitro, platinum-based chemotherapy induced TF/phosphatidylserine microparticle shedding from A549 and A427 lung cancers cells, which enhanced thrombin generation in plasma in a FVII-dependent manner. CFDNA levels were increased in supernatants of chemotherapy-treated neutrophils and plasma of chemotherapy-treated mice. TF microparticles were elevated in plasma of chemotherapy-treated tumour-bearing mice. Plasma CFDNA levels are increased in chemotherapy-treated tumour-free mice and correlate with increased thrombin generation. In tumour-bearing mice, chemotherapy increases plasma levels of CFDNA and TF/phosphatidylserine microparticles. Platinum-based chemotherapy induces the shedding of TF/phosphatidylserine microparticles from tumour cells and the release of CFDNA from host neutrophils.
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50
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Wehler T, Thomas M, Schumann C, Bosch-Barrera J, Viñolas Segarra N, Dickgreber NJ, Dalhoff K, Sebastian M, Corral Jaime J, Alonso M, Hynes SM, Lin J, Hurt K, Bence Lin A, Calvo E, Paz-Ares L. A randomized, phase 2 evaluation of the CHK1 inhibitor, LY2603618, administered in combination with pemetrexed and cisplatin in patients with advanced nonsquamous non-small cell lung cancer. Lung Cancer 2017. [PMID: 28625637 DOI: 10.1016/j.lungcan.2017.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This phase 2 portion of a phase 1/2 study examined the efficacy and safety of LY2603618, a selective checkpoint kinase 1 inhibitor, combined with pemetrexed and cisplatin (LY+Pem+Cis) in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). This multicenter, randomized, controlled, open-label study (NCT01139775) enrolled patients with stage IV nonsquamous NSCLC and an Eastern Cooperative Oncology Group performance status ≤1. Patients were randomized (2:1) to LY+Pem+Cis or pemetrexed and cisplatin (Pem+Cis). Induction therapy comprised four 21-day cycles of 500 mg/m2 pemetrexed and 75mg/m2 cisplatin on Day 1 (both arms) and 275mg LY2603618 on Day 2 (LY+Pem+Cis arm). Maintenance therapy comprised 500mg/m2 pemetrexed on Day 1 (both arms) and 275mg LY2603618 on Day 2 (LY+Pem+Cis arm) until disease progression. The primary endpoint was progression-free survival (PFS). Enrollment was permanently halted before target enrollment was met due to a greater number of thromboembolic events in the LY+Pem+Cis arm. Sixty-two patients were enrolled (LY+Pem+Cis, n=39; Pem+Cis, n=23). Bayesian and frequentist analysis demonstrated superior PFS in the LY+Pem+Cis arm vs the Pem+Cis arm (median [90% confidence interval]: LY+Pem+Cis, 4.7 months [4.-7.1]; Pem+Cis, 1.5 months [1.3-2.9]; P=0.022). Seven patients in the LY+Pem+Cis arm (vs 0 in the Pem+Cis arm) experienced serious thromboembolic events: pulmonary embolism (n=5), ischemic stroke (n=1), and cerebrovascular accident (n=1). Although the primary endpoint was met, the combination of LY2603618+Pem+Cis will not be further developed for treating advanced nonsquamous NSCLC due to the potential increased risk of thromboembolic events with this combination. ClinicalTrials.gov Identifier: NCT01139775.
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Affiliation(s)
- Thomas Wehler
- III. Medical Department, University Hospital Mainz, Mainz, Germany; 5th Medical Department, University Hospital Saarland, Homburg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center, Heidelberg, Germany
| | - Christian Schumann
- Department of Internal Medicine II, University Clinic Ulm, Ulm, Germany; Klinik für Pneumologie, Thoraxonkologie, Schlaf-und Beatmungsmedizin, Klinikverbund Kempten-Oberallgäu, Kempten and Immenstadt, Germany
| | - Joaquim Bosch-Barrera
- Department of Medical Oncology, Catalan Institute of Oncology, Doctor Josep Trueta University Hospital, Girona, Spain
| | | | - Nicolas J Dickgreber
- Department of Respiratory Medicine and Thoracic Oncology, Mathias-Spital Rheine, Rheine, Germany
| | - Klaus Dalhoff
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Martin Sebastian
- Department of Hematology/Oncology, Rheumatology, HIV, J.W. Goethe University, Frankfurt, Germany
| | | | - Miriam Alonso
- University Hospital Virgen del Rocío, Seville, Spain
| | | | - Ji Lin
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Karla Hurt
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Emiliano Calvo
- START Madrid, Clara Campal Comprehensive Cancer Center, Medical Oncology Division, Madrid Norte Sanchinarro University Hospital, Madrid, Spain
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, Madrid, Spain; CNIO, Madrid, Spain; Universidad Complutense, Madrid, Spain; CIBEROnc, Madrid, Spain.
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