1
|
Carmona-Bayonas A, Verso M, Sánchez Cánovas M, Rubio Pérez J, García de Herreros M, Martínez de Prado P, Fernández Pérez I, Quintanar Verdúguez T, Obispo B, Pachón V, Gómez D, Ortega L, Serrano Moyano M, Brozos EM, Biosca M, Antonio M, Teijeira Sánchez L, Hernández Pérez C, Cumplido Burón JD, Martínez Lago N, García Pérez E, Muñoz Langa J, Perez-Segura P, Martínez de Castro E, Jiménez-Fonseca P, Agnelli G, Muñoz A. Do antiangiogenics promote clot instability? Data from the TESEO prospective registry and Caravaggio clinical trial. Thromb Haemost 2022; 122:1653-1661. [PMID: 35381615 PMCID: PMC9512585 DOI: 10.1055/a-1816-8347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background
Venous thromboembolism (VTE) is a common complication in cancer patients. Much of its morbidity stems from the development of fatal pulmonary embolisms (PE). Little is known about the factors involved in clot stability, with angiogenesis possibly being implicated.
Methods
The database is from the TESEO prospective registry that recruits cancer patients with VTE from 41 Spanish hospitals. Independent validation was conducted in a cohort from the Caravaggio trial. The objective is to evaluate the association between exposure to antiangiogenic therapies and the PE/VTE proportion in oncological patients.
Results
In total, 1,536 subjects were evaluated; 58.4% (
n
= 894) had a PE and 7% (
n
= 108) received antiangiogenic therapy (bevacizumab in 75%). The PE/VTE proportion among antiangiogenic-treated individuals was 77/108 (71.3%) versus 817/1,428 (57.2%) among those receiving other alternative therapies (
p
= 0.004). The effect of the antiangiogenics on the PE/VTE proportion held up across all subgroups except for active smokers or those with chronic obstructive pulmonary disease. Exposure to antiangiogenics was associated with increased PEs, odds ratio (OR) 2.27 (95% CI, 1.42–3.63). In the Caravaggio trial, PE was present in 67% of the individuals treated with antiangiogenics, 50% of those who received chemotherapy without antiangiogenic treatment, and 60% without active therapy (
p
= 0.0016).
Conclusion
Antiangiogenics are associated with increased proportion of PE in oncological patients with VTE. If an effect on clot stability is confirmed, the concept of thrombotic risk in cancer patients should be reconsidered in qualitative terms.
Collapse
Affiliation(s)
| | - Melina Verso
- Dep. of Internal Medicine, Perugia Hospital Authority, Perugia, Italy
| | - Manuel Sánchez Cánovas
- Hematología y Oncología Médica, Hospital General Universitario Jose M Morales Meseguer, Murcia, Spain
| | | | | | | | | | | | - Berta Obispo
- Hospital Universitario Infanta Leonor Servicio de Medicina Interna, Madrid, Spain
| | - Vanessa Pachón
- Oncology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - David Gómez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Laura Ortega
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Elena María Brozos
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mercè Biosca
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Maite Antonio
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine,Department of Internal Medicine, Perugia Hospital Authority, Perugia, Italy
| | - Andres Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| |
Collapse
|
2
|
Carmona-Bayonas A, Gómez D, Martínez de Castro E, Pérez Segura P, Muñoz Langa J, Jimenez-Fonseca P, Sánchez Cánovas M, Ortega Moran L, García Escobar I, Rupérez Blanco AB, Fernández Pérez I, Martínez de Prado P, Porta I Balanyà R, Quintanar Verduguez T, Rodríguez-Lescure Á, Muñoz A. A snapshot of cancer-associated thromboembolic disease in 2018-2019: First data from the TESEO prospective registry. Eur J Intern Med 2020; 78:41-49. [PMID: 32482596 DOI: 10.1016/j.ejim.2020.05.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. METHOD TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. RESULTS Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. CONCLUSION CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.
Collapse
Affiliation(s)
- Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - David Gómez
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, UPV/EHU, Oviedo, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Pedro Pérez Segura
- Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - José Muñoz Langa
- Medical Oncology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Manuel Sánchez Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - Laura Ortega Moran
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio García Escobar
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Rut Porta I Balanyà
- Medical Oncology Department, Hospital Universitari Dr Josep Trueta, Institut Català d'Oncologia, Girona, Spain and Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Spain
| | | | | | - Andrés Muñoz
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain.
| |
Collapse
|
3
|
Espinosa E, Soriano V, Malvehy J, Berrocal A, Martínez de Prado P, Quindós M, Soria A, Márquez-Rodas I, Palacio I, Cerezuela P, López-Vivanco G, Alonso L, Samaniego E, Ballesteros A, Puértolas T, Díaz-Beveridge R, de la Cruz-Merino L, López Castro R, López López R, Stevinson K, del Barrio P, Tornamira MV, Guillém V, Martín-Algarra S. Treatment patterns of adjuvant interferon-α2b for high-risk melanoma: a retrospective study of the Grupo Español Multidisciplinar de Melanoma - Prima study. Melanoma Res 2016; 26:278-83. [PMID: 26958991 PMCID: PMC4861701 DOI: 10.1097/cmr.0000000000000254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/17/2016] [Indexed: 01/29/2023]
Abstract
Adjuvant interferon-α2b (IFN-α2b) has been studied extensively in clinical trials, but there have been few studies of real-world use. The aim of this study is to describe the IFN-α2b real-world patterns in patients with high-risk melanoma in Spain. This was a retrospective and multicentre chart review study of an unselected cohort of patients with melanoma at high risk for relapse (stage IIB/IIC/III) treated with IFN-α2b. Patterns were assessed in terms of dose and compliance to planned treatment. A survival analysis was carried out for the full population and according to Kirkwood scheme compliance and the presence of ulceration. Of 327 patients treated with IFN-α2b, 318 received a high-dose regimen following the standard Kirkwood scheme; thus, patterns are described for this regimen. A total of 121 (38%) and 88 (28%) patients had at least one dose reduction during the induction and maintenance phases, respectively. Dose delay was required in fewer than 10% of patients. A total of 78, 40 and 38% of the patients completed the induction phase, maintenance phase and completed treatment, respectively. The median progression-free and overall survival for the full population were 3.2 and 10.5 years, respectively. There were no differences in progression-free survival and overall survival according to Kirkwood scheme compliance and the presence of ulceration. The most frequent adverse events were neutropenia (31%) and fatigue (30%). High-dose IFN-α2b is the most frequently used regimen in Spain as an adjuvant systemic treatment for high-risk melanoma. Despite poor compliance, in this retrospective study, IFN-α2b treatment provided a benefit consistent with that described previously.
Collapse
Affiliation(s)
| | | | - Josep Malvehy
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona
| | - Alfonso Berrocal
- Medical Oncology Service, Hospital General Universitario de Valencia
| | | | - María Quindós
- Medical Oncology Service, Hospital Teresa Herrera, La Coruña
| | - Ainara Soria
- Medical Oncology Service, Hospital Ramón y Cajal
| | - Iván Márquez-Rodas
- Medical Oncology Service, Instituto de Investigación Sanitaria Gregorio Marañon
| | - Isabel Palacio
- Medical Oncology Service, Hospital Central de Asturias, Oviedo
| | - Pablo Cerezuela
- Medical Oncology Service, Hospital General Universitario Santa Lucía, Cartagena
| | | | - Lorenzo Alonso
- Medical Oncology Service, Hospital Universitario Virgen de la Victoria, Málaga
| | - Elia Samaniego
- Dermatology Service, Complejo Asistencial Universitario de León, León
| | | | | | | | | | - Rafael López Castro
- Medical Oncology Service, Hospital Clínico Universitario de Valladolid, Valladolid
| | - Rafael López López
- Medical Oncology Service, Hospital Clínico Universitario de Santiago, Santiago de Compostela
| | - Kendall Stevinson
- Global Health Outcomes Research, Merck Sharp & Dohme, Kenilworth, New Jersey, USA
| | | | | | | | | |
Collapse
|
4
|
Díaz-Rubio E, Gómez-España A, Massutí B, Sastre J, Abad A, Valladares M, Rivera F, Safont MJ, Martínez de Prado P, Gallén M, González E, Marcuello E, Benavides M, Fernández-Martos C, Losa F, Escudero P, Arrivi A, Cervantes A, Dueñas R, López-Ladrón A, Lacasta A, Llanos M, Tabernero JM, Antón A, Aranda E. First-line XELOX plus bevacizumab followed by XELOX plus bevacizumab or single-agent bevacizumab as maintenance therapy in patients with metastatic colorectal cancer: the phase III MACRO TTD study. Oncologist 2012; 17:15-25. [PMID: 22234633 DOI: 10.1634/theoncologist.2011-0249] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this phase III trial was to compare the efficacy and safety of bevacizumab alone with those of bevacizumab and capecitabine plus oxaliplatin (XELOX) as maintenance treatment following induction chemotherapy with XELOX plus bevacizumab in the first-line treatment of patients with metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Patients were randomly assigned to receive six cycles of bevacizumab, capecitabine, and oxaliplatin every 3 weeks followed by XELOX plus bevacizumab or bevacizumab alone until progression. The primary endpoint was the progression-free survival (PFS) interval; secondary endpoints were the overall survival (OS) time, objective response rate (RR), time to response, duration of response, and safety. RESULTS The intent-to-treat population comprised 480 patients (XELOX plus bevacizumab, n = 239; bevacizumab, n = 241); there were no significant differences in baseline characteristics. The median follow-up was 29.0 months (range, 0-53.2 months). There were no statistically significant differences in the median PFS or OS times or in the RR between the two arms. The most common grade 3 or 4 toxicities in the XELOX plus bevacizumab versus bevacizumab arms were diarrhea, hand-foot syndrome, and neuropathy. CONCLUSION Although the noninferiority of bevacizumab versus XELOX plus bevacizumab cannot be confirmed, we can reliably exclude a median PFS detriment >3 weeks. This study suggests that maintenance therapy with single-agent bevacizumab may be an appropriate option following induction XELOX plus bevacizumab in mCRC patients.
Collapse
|