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Aguiar De Azevedo L, Orione C, Tromeur C, Couturaud F, Descourt R, Geier M. Incidence of venous thromboembolism and association with PD-L1 expression in advanced non-small cell lung cancer patients treated with first-line chemo-immunotherapy. Front Oncol 2024; 13:1221106. [PMID: 38260845 PMCID: PMC10800377 DOI: 10.3389/fonc.2023.1221106] [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: 05/11/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background Venous thromboembolism (VTE) is a serious complication in non-small cell lung cancer (NSCLC) patients. The use of thromboprophylactic therapy is subject to an accurate assessment of the VTE risk depending on patients, tumor characteristics and type of systemic antineoplastic treatments. However, little is known concerning the risk of VTE in patients suffering from an advanced NSCLC treated with first-line chemo-immunotherapy and the impact of tumor biomarkers such as PD-L1 expression. Methods We performed a retrospective, observational, single-centre study in a cohort of advanced NSCLC patients treated with first-line chemo-immunotherapy. The primary endpoint was the incidence of VTE. Secondary endpoints were the cumulative incidence of VTE, the impact of PD-L1 on VTE occurrence, overall survival, the rate of VTE recurrence under anticoagulant treatment and the rate of bleeding complications. Results 109 patients were included, of whom 21 (19.3%) presented a VTE event during a median follow-up of 13 months. VTE incidence at 3, 6 and 12 months was 12.1%, 15.1% and 17.5% respectively. 61% were pulmonary embolisms, 9.5% were isolated deep vein thrombosis and 14.3% were central venous catheter-related thrombosis. Our study did not show a significant impact of PD-L1 on VTE occurrence. Overall survival at 6, 12 and 24 months was 81.9%, 74.4% and 70.3% respectively. Four patients developed a recurrent VTE under anticoagulation therapy 3 to 5 months after the first VTE event. One patient suffered from a major bleeding complication while under anticoagulation therapy, leading to death. Conclusion VTE is a common complication in advanced NSCLC patients treated with concomitant chemo-immunotherapy. In our study, 19.3% of patients developed a VTE during a median follow-up of 13 months. PD-L1 did not appear to be associated with VTE occurrence. We recorded high VTE recurrence rates despite anticoagulant treatment. Further investigations are needed to determine if high PD-L1 expression is associated with VTE.
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Affiliation(s)
| | - Charles Orione
- Service de Pneumologie, Centre Hospitalier de Cornouaille, Quimper, France
| | - Cécile Tromeur
- Service de Pneumologie, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
| | - Francis Couturaud
- Service de Pneumologie, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
| | - Renaud Descourt
- Service d’oncologie médicale, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
| | - Margaux Geier
- Service d’oncologie médicale, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
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Couturaud F, Mahé I, Schmidt J, Gleize JC, Lafon T, Saighi A, Sedjelmaci F, Bertoletti L, Mismetti P. Adult breast, lung, pancreatic, upper and lower gastrointestinal cancer patients with hospitalized venous thromboembolism in the national French hospital discharge database. BMC Cancer 2023; 23:531. [PMID: 37301828 DOI: 10.1186/s12885-023-10877-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) and cancer are strongly associated. In France, evidence on patients with pancreatic, upper GI [gastrointestinal], lower GI, lung, or breast cancer-associated VTE and their hospital management is limited. The aims of this study were to provide data on the number of hospitalized VTE events among cancer patients, the patients' characteristics, and their hospital management to estimate the burden of disease and the hospital burden of cancer-related VTE and to provide guidance on research. METHODS This longitudinal, observational, and retrospective study was based on the comprehensive hospital discharge database (PMSI). Adult patients (≥ 18 years old) hospitalized with a cancer of interest in 2016 and hospitalized (within 2 years with VTE (captured a as a principal, related, or significant associated diagnosis) were included in the study. RESULTS We identified 340,946 cancer patients, of which 7.2% (24,433 patients) were hospitalized with VTE. The proportions of hospitalized VTE were 14.6% (3,237) for patients with pancreatic cancer, 11.2% (8,339) for lung cancer, 9.9% (2,232) for upper GI cancer, 6.7% (7,011) for lower GI cancer, and 3.1% (3,614) for breast cancer. Around two thirds of cancer patients with a hospitalized VTE had active cancer (with metastases and/or receiving chemotherapy during the six months prior to the index date): from 62% of patients with pancreatic cancer to 72% with breast cancer. Around a third of patients were admitted to the hospital through the emergency room, up to 3% of patients stayed in an intensive care unit. The average length of stay ranged from 10 (breast cancer) to 15 days (upper GI cancer). Nine (lower GI cancer) to 18% (pancreatic cancer) of patients died during the VTE hospital stay. CONCLUSIONS The burden of cancer-associated VTE is substantial, both in terms of the number of patients affected and in the hospital use. These findings offer guidance on future research on VTE prophylaxis in a very high-risk population, particularly in patients with active cancer.
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Affiliation(s)
- F Couturaud
- Univ Brest, INSERM U1304-GETBO, Département de médecine interne et pneumologie, CHU Brest, Brest, France.
- FCRIN INNOVTE, Saint-Etienne, France.
| | - I Mahé
- FCRIN INNOVTE, Saint-Etienne, France
- Université de Paris, APHP, Hôpital Louis Mourier, Service de Médecine Interne, Colombes, France
- Innovative Therapies in Haemostasis, INSERM, Paris, France
| | - J Schmidt
- FCRIN INNOVTE, Saint-Etienne, France
- CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | - L Bertoletti
- FCRIN INNOVTE, Saint-Etienne, France
- Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France
| | - P Mismetti
- FCRIN INNOVTE, Saint-Etienne, France
- Service de Médecine Vasculaire Et Thérapeutique, CHU de St-Etienne, Saint-Etienne, France
- INSERM, UMR1059, Université Jean-Monnet, Saint-Etienne, France
- INSERM, CIC-1408, CHU de Saint-Etienne, Saint-Etienne, France
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Gounant V, Brosseau S, Lorut C, Guezour N, Vauchier C, Mohammad W, Khalil A, Zalcman G. [Non-infectious respiratory emergencies in patients with cancer]. Rev Mal Respir 2023; 40:416-427. [PMID: 37085441 DOI: 10.1016/j.rmr.2023.03.006] [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: 02/23/2023] [Accepted: 03/13/2023] [Indexed: 04/23/2023]
Abstract
Patients with a solid tumor or hematologic malignancy are often addressed to emergency units for an acute respiratory complication associated with the underlying cancer or secondary to treatments. The current article is part of a thematic series: "Intensive care and emergencies in solid tumours and blood cancer patients" and will develop the following points: (1) malignant proximal airway obstruction and, more specifically, the role of therapeutic bronchoscopy; (2) superior vena cava syndrome by tumor compression and/or secondary to thrombosis (diagnosis, local and systemic treatments); (3) cancer-related pulmonary embolism (incidence, indications for low-molecular weight heparins and direct oral anticoagulants). Other respiratory emergencies will be dealt in the other articles of this series.
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Affiliation(s)
- V Gounant
- Université Paris-Cité, France; CIC Inserm 1425, service d'oncologie thoracique, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France.
| | - S Brosseau
- Université Paris-Cité, France; CIC Inserm 1425, service d'oncologie thoracique, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France
| | - C Lorut
- Université Paris-Cité, France; Service de pneumologie, hôpital Cochin, GHU Paris-Centre, Institut Cochin (UMR 1016), Assistance publique-Hôpitaux de Paris, France
| | - N Guezour
- Université Paris-Cité, France; CIC Inserm 1425, service d'oncologie thoracique, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France
| | - C Vauchier
- Université Paris-Cité, France; CIC Inserm 1425, service d'oncologie thoracique, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France
| | - W Mohammad
- Université Paris-Cité, France; Service de radiologie, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France
| | - A Khalil
- Université Paris-Cité, France; Service de radiologie, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France
| | - G Zalcman
- Université Paris-Cité, France; CIC Inserm 1425, service d'oncologie thoracique, hôpital Bichat-Claude-Bernard, GHU de Paris-Nord, Institut du cancer Paris-Nord, Assistance publique-Hôpitaux de Paris, France
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Debourdeau P, Bertoletti L, Font C, López-Núñez JJ, Gómez-Cuervo C, Mahe I, Otero-Candelera R, Adarraga MD, López-Miguel P, Monreal M. Three-Month Outcomes in Cancer Patients with Superficial or Deep Vein Thrombosis in the Lower Limbs: Results from the RIETE Registry. Cancers (Basel) 2023; 15:cancers15072034. [PMID: 37046695 PMCID: PMC10093050 DOI: 10.3390/cancers15072034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: The clinical characteristics and outcomes of cancer patients with lower-limb isolated superficial vein thrombosis (SVT) have not been consistently evaluated. Methods: We used data in the RIETE registry to compare the clinical characteristics and 90-day outcomes for patients with: (1) active cancer and lower-limb SVT; (2) active cancer and lower-limb deep vein thrombosis (DVT); (3) lower-limb SVT without cancer. The primary outcomes included subsequent symptomatic SVT, DVT or pulmonary embolism (PE). Secondary outcomes were major bleeding and death. Results: From March 2015 to April 2021, there were 110 patients with cancer and SVT, 1695 with cancer and DVT, and 1030 with SVT but no cancer. Most patients in all subgroups (93%, 99% and 96%, respectively) received anticoagulants, while those with SVT received lower daily doses of low-molecular-weight heparin (114 ± 58, 163 ± 44, and 106 ± 50 IU/kg, respectively). During the first 90 days, 101 patients (3.6%) developed subsequent VTE (PE 47, DVT 41, SVT 13), whereas 72 (2.5%) had major bleeding and 282 (9.9%) died. Among the three groups, 90-day events were, respectively: VTE at rates of 7.3%, 4.0% and 2.4%; major bleeding at rates of 2.7%, 3.9% and 0.3%; mortality at rates of 8.2%, 16% and 0.3%. Between D90 and D180, only one SVT recurrence and one death occurred in SVT cancer patients. In multivariable analysis, cancer was associated with subsequent VTE (HR = 2.04; 1.15–3.62), while initial presentation as SVT or DVT were not associated with a different risk. Conclusions: The risk for subsequent VTE (including symptomatic SVT, DVT or PE) was similar in cancer patients with isolated SVT than in those with isolated DVT.
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Malka D, Girard N, Smadja DM, Chevreau C, Culine S, Lesur A, Rouzier R, Rozet F, Spano JP, Blay JY. [Prophylaxis and management of cancer-associated thrombosis: Practical issues about anticoagulant use]. Bull Cancer 2023; 110:212-224. [PMID: 36494243 DOI: 10.1016/j.bulcan.2022.10.008] [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] [Received: 06/16/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022]
Abstract
Cancer-associated thrombosis (CAT) is a common complication resulting from various vascular mechanisms related to cancer, antitumoral therapy and patient status, and is associated with a poor prognosis. Anticoagulants recommended for CAT treatment or prevention mainly include low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs). Regarding thromboprophylaxis, a situation for which LMWH is a preferred option due to a lower risk of hemorrhage especially in patients with unresected gastro-intestinal and genito-urinary malignancies, the identification of patients at risk is a major issue. For patients with established CAT, the main issue is the choice of the most appropriate anticoagulant therapy. Because of the convenience of oral formulation, DOACs are an attractive option, and their efficacy has been shown in randomized trials. However, such studies are limited by selection biases, which make the analyzed population not representative of the real-life setting, as for instance cancers associated with a high risk of hemorrhage, or antitumoral therapies (e.g., tyrosine kinase inhibitors) known to interact with DOACs and then modifying their bioavailability. Caution associated with DOAC use is highlighted by most updated guidelines that recommend a case-by-case-based approach. The aim of the present paper is to help the oncologists make the most appropriate decision regarding the choice of anticoagulant therapy in a context of thromboprophylaxis or established CAT management in a patient with a solid tumor. The main issues are addressed through key practical questions, the answers of which are based on the current guidelines and additional published data or expert opinions.
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Affiliation(s)
- David Malka
- Institut mutualiste Montsouris, département d'oncologie médicale, Paris, France; Université Paris-Saclay, unité dynamique des cellules tumorales INSERM U1279, Gustave Roussy, Villejuif, France.
| | - Nicolas Girard
- Institut Curie, institut du Thorax Curie-Montsouris, Paris, France
| | - David M Smadja
- Université de Paris, INSERM innovations thérapeutiques en hémostase, Paris, France; Hôpital Européen Georges-Pompidou, AP-HP, département d'hématologie, Paris, France; Réseau F-CRIN INNOVTE, Paris, France
| | | | - Stéphane Culine
- Université Paris Cité, service d'oncologie médicale, AP-HP Saint-Louis, Paris, France
| | - Anne Lesur
- Mutuelle générale éducation nationale, Nancy, France
| | - Roman Rouzier
- Centre François Baclesse, département de Chirurgie, Caen, France
| | - François Rozet
- Institut mutualiste Montsouris, département d'urologie, Paris, France
| | - Jean-Philippe Spano
- Hôpital La Pitié-Salpêtrière, service d'oncologie médicale, AP-HP-SU, IUC, Paris, France
| | - Jean-Yves Blay
- Centre Leon Bérard and UCBL1, département d'oncologie médicale, Lyon, France
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Mahé I, Chapelle C, Plaisance L, Bertoletti L, Mismetti P, Mayeur D, Mahé G, Couturaud F. Management of Cancer-Associated Thrombosis in France: A National Survey among Vascular Disease and Supportive Care Specialists. Cancers (Basel) 2022; 14:cancers14174143. [PMID: 36077680 PMCID: PMC9454850 DOI: 10.3390/cancers14174143] [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: 07/08/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Patients with venous thromboembolism events in the context of cancer should receive anticoagulants for at least 6 months. Both low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are considered in international guidelines, with a different approach. To investigate the determinants of decision, at thrombosis diagnosis and after 6 months, and the practices when facing special situations, such as venous thromboembolic recurrence or thrombocytopenia, we designed a survey among specialists of cancer-associated thromboembolism, including vignettes about patients with different cancer sites and questions. We considered points related to cancer disease, anticancer treatments and characteristics of patients. Abstract Low molecular weight heparins (LMWHs) are recommended by international guidelines for at least 6 months in patients with cancer-associated thromboembolism (CAT). Direct oral anticoagulants (DOACs) have been proposed as an alternative to LMWH. In clinical practice, the specialists in charge of CAT have to decide which anticoagulant to prescribe. An electronic survey tool, including vignettes and questions, was sent to members of the French Society of Vascular Medicine, the French-speaking association for supportive care in oncology and the Investigation Network On Venous Thrombo-Embolism. Among the 376 respondents, LMWHs were reported as the first choice by most specialists. The prescription of DOACs within the first 3 weeks of CAT diagnosis was highly dependent on the cancer site: 5.9%, 18.6% and 24.5% in patients with locally advanced colorectal, lung and breast cancer, respectively. The determinants were mostly related to cancer (site and stage or evolution) and to anticancer treatments. For 61% of physicians, some anticancer treatments were contraindications to DOACs. However, almost 90% of physicians considered switching to DOAC after a median 3-month period of LMWHs. In daily practice, LMWHs and DOACs are now considered by specialists of CAT; the decision is mostly driven by the site of cancer. The role of anticancer treatments in the decision remains to be investigated.
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Affiliation(s)
- Isabelle Mahé
- Université Paris Cité, 75006 Paris, France
- Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, 92700 Colombes, France
- Innovative Therapies in Haemostasis, INSERM UMR_S1140, 75006 Paris, France
- INNOVTE-FCRIN (Investigation Network On Venous Thrombo-Embolism), 42055 Saint-Etienne, France
- Correspondence:
| | - Céline Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie, CHU de Saint-Etienne, 42270 Saint-Etienne, France
- SAINBIOSE INSERM U1059, Université Jean Monnet, Université de Lyon, 42023 Saint-Etienne, France
| | - Ludovic Plaisance
- Université Paris Cité, 75006 Paris, France
- Service de Médecine Interne, Hôpital Louis Mourier, AP-HP, 92700 Colombes, France
| | - Laurent Bertoletti
- INNOVTE-FCRIN (Investigation Network On Venous Thrombo-Embolism), 42055 Saint-Etienne, France
- SAINBIOSE INSERM U1059, Université Jean Monnet, Université de Lyon, 42023 Saint-Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, 42055 Saint-Etienne, France
- INSERM CIC-1408, CHU de St-Etienne, 42055 Saint-Etienne, France
| | - Patrick Mismetti
- INNOVTE-FCRIN (Investigation Network On Venous Thrombo-Embolism), 42055 Saint-Etienne, France
- SAINBIOSE INSERM U1059, Université Jean Monnet, Université de Lyon, 42023 Saint-Etienne, France
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, 42055 Saint-Etienne, France
- INSERM CIC-1408, CHU de St-Etienne, 42055 Saint-Etienne, France
| | - Didier Mayeur
- Oncology Department, Centre Georges François Leclerc, 1, Rue Professeur Marion, BP77980, CEDEX, 21079 Dijon, France
| | - Guillaume Mahé
- Unité de Médecine Vasculaire, CHU Rennes, 35000 Rennes, France
- INSERM CIC 1414, 35200 Rennes, France
- University of Rennes 1, 35000 Rennes, France
- University of Rennes 2, M2S-EA 7470, 35000 Rennes, France
| | - Francis Couturaud
- INNOVTE-FCRIN (Investigation Network On Venous Thrombo-Embolism), 42055 Saint-Etienne, France
- Département de Médecine Interne et Pneumologie, INSERM U1304 (GETBO), CHU Brest, Université de Bretagne Occidentale, 29238 Brest, France
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Hindré R, Hamdan A, Pastré J, Planquette B, Sanchez O. Traitement de la maladie veineuse thromboembolique au cours du cancer. Bull Cancer 2022; 109:528-536. [DOI: 10.1016/j.bulcan.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/27/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
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