Incidence of venous thromboembolic events in cancer patients receiving immunotherapy: a single-institution experience
L Gutierrez-Sainz 1 , V Martinez-Marin 2 3 4 , D Viñal 2 , D Martinez-Perez 2 , J Pedregosa 2 , J A Garcia-Cuesta 2 , J Villamayor 2 , P Zamora 2 3 5 , A Pinto 2 3 , A Redondo 2 3 5 6 , B Castelo 2 3 5 6 , P Cruz 2 , O Higuera 2 , A Custodio 2 3 , A Gallego 2 , D Sanchez-Cabrero 2 , J de Castro-Carpeño 2 3 5 7 6 , E Espinosa 2 3 5 7 6 , J Feliu 2 3 5 7 6
Background: Cancer and cancer therapies have been associated with an increased incidence of venous thromboembolic events (VTE). However, the incidence of VTE in patients on immunotherapy has not been well characterized. The aim of this study was to assess the incidence of VTE in cancer patients receiving immunotherapy and ascertain its prognostic utility.
Materials and methods: We conducted a single-institution retrospective study, including all cancer patients treated with anti-Programmed cell Death 1 (PD-1), anti-Programmed cell Death Ligand-1 (PD-L1), anti-Cytotoxic T-Lymphocyte-Associated Protein 4 (CTLA4), a combination of anti-PD-1/anti-PD-L1 and anti-CTLA4 or a combination including any of these drugs with chemotherapy, antiangiogenic agents or both between June 2013 and April 2019 at La Paz University Hospital, Madrid (Spain).
Results: We selected 229 patients. VTE occurred in 16 of 229 patients (7%). VTE occurred more frequently in patients with lung cancer followed by melanoma. Female sex and melanoma were independently associated with an increased risk of VTE. 12 of 16 VTE (75%) were symptomatic. Progressive disease to immunotherapy [HR 31.60 (95% CI 11.44-87.22), p = 0.00], lung cancer [HR 2.55 (95% CI 1.34-4.86), p = 0.00] and melanoma [HR 2.42 (1.20-4.86), p = 0.01] were independently associated with shorter OS. VTE occurrence was not independently associated with shorter OS [HR 1.33 (95% CI 0.63-2.80), p = 0.44].
Conclusions: The incidence of VTE in cancer patients receiving immunotherapy in our study appeared to be similar to the incidence previously reported in other series of cancer patients treated with systemic therapies. VTE occurrence did not correlate with the prognosis. Further and prospective studies are needed to derive definitive conclusions.