Clinical impact of venous thromboembolism in non-small cell lung cancer patients receiving immunotherapy. Issue 221 (January 2023)

• Record Type: Journal Article
• Authors: Bjørnhart, Birgitte; Kristiansen, Charlotte; Asmussen, Jon; Hansen, Karin Holmskov; Wedervang, Kim; Jørgensen, Trine Lembrecht; Herrstedt, Jørn; Schytte, Tine
• Is Part Of: Thrombosis research. Issue 221(2023)
• Page Start: 164
• Page End: 172
• Publication Date: 2023-01
• Subjects: Non-small cell lung cancer -- Immunotherapy -- Venous thromboembolism -- Survival -- Real-world -- Adverse events; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2022.10.020
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: Prospective investigation on cancer-associated venous thromboembolism (VTE) in non-small cell lung cancer (NSCLC) during treatment with immune checkpoint inhibitors (ICIs) is lacking. Patients and methods: A prospective real-world study using combined computed tomography venography and pulmonary angiography (CTVPA) to screen patients with NSCLC for VTE (cohort A). A retrospective multicenter cohort without additional screening with CTVPA was included as control (cohort B). A model with VTE as a time-dependent event using competing risk analysis model with death as a competing event was used to evaluate outcomes and differences in cumulative VTE incidences. Results: Cohort A (n = 146) and cohort B (n = 426) had median follow-up for VTE of 16.5 months (IQR 6.7–35.6). Cumulative VTE events at 1, 3, 6, and 12 months were 7.5 %, 9.6 %, 13.0 %, 14.4 % for cohort A and 1.9 %, 3.8 %, 4.9 %, 5.6 % for cohort B with SHR 2.42 (CI 95 % 1.37–4.27) p = 0.0024. Recurrent VTE comprised 52 % and 37 %, respectively. In multivariate overall survival analysis, VTE was significantly associated with impaired OS (HR 2.12 CI 95 % [1.49–3.03], p < 0.0001). Risk factors for VTE comprised prior VTE and ICI administered in first line. Conclusion: Cumulative VTE incidence in NSCLC patients following palliative ICI may be significantly higher than reported in randomised clinical trials and retrospective real-world reports. VTE development during ICI impair OS significantly. Thus, more focus on VTE during ICI is warranted to optimise both prevention and management of VTE. Whether there is a causal relationship between VTE and ICI remains to be explored.