151
|
Abdel-Razeq H, Mansour A, Abdulelah H, Al-Shwayat A, Makoseh M, Ibrahim M, Abunasser M, Rimawi D, Al-Rabaiah A, Alfar R, Abufara A, Ibrahim A, Bawaliz A, Ismael Y. Thromboembolic events in cancer patients on active treatment with cisplatin-based chemotherapy: another look! Thromb J 2018; 16:2. [PMID: 29507532 PMCID: PMC5831696 DOI: 10.1186/s12959-018-0161-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/02/2018] [Indexed: 02/06/2023] Open
Abstract
Background The risk of thromboembolic events is higher among cancer patients, especially in patients undergoing chemotherapy. Cisplatin-based regimens claim to be associated with a very high thromboembolic rate. In this study, we report on our own experience with thrombosis among patients on active cisplatin-based chemotherapy. Methods Medical records and hospital databases were searched for all the patients treated with any cisplatin-based regimen for any kind of cancer. Thrombosis was considered cisplatin-related if diagnosed any time after the first dose and up to 4 weeks after the last. The Khorana risk assessment model was performed in all cases. Results A total of 1677 patients (65.5% males, median age: 50 years) treated with cisplatin-based regimens were identified. Head and neck (22.9%), lung (22.2%), lymphoma and gastric (11.4% each) were the most common primary tumors. Thromboembolic events were reported in 110 (6.6%); the highest was in patients with gastric cancer (20.9%) and the lowest in patients with head and neck cancers (2.3%) and lymphoma (1.6%). Thrombosis included deep vein thrombosis (DVT) in 69 (62.7%), pulmonary embolism (PE) in 18 (16.9%) and arterial thrombosis in 17 (15.6%). A majority (51.1%) of the patients had stage IV disease and only 16% had stage I or II.In a multivariate analysis, significantly higher rates of thrombosis were associated with gastric as the primary tumor, advanced-stage disease, female sex but not age, and the Khorana risk score or type of cisplatin regimen. While the presence of CVC was significantly associated with the risk of thrombosis (p < 0.0001) in the univariate analysis, and such significance was lost in the multivariate analysis (odds ratio, 1.098; 95%CI, 0.603-1.999, p = 0.7599). Conclusions Thromboembolic events in cancer patients on active cisplatin-based chemotherapy were commonly encountered. Gastric cancer, regardless of other clinical variables, was associated with the highest risk.
Collapse
Affiliation(s)
- Hikmat Abdel-Razeq
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Asem Mansour
- 2Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Hazem Abdulelah
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Anas Al-Shwayat
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Mohammad Makoseh
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Mohammad Ibrahim
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Mahmoud Abunasser
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Dalia Rimawi
- 3Scientific and Reseaerch Office, King Hussein Cancer Center, Amman, Jordan
| | | | - Rozan Alfar
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Alaa' Abufara
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Alaa Ibrahim
- 2Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Anas Bawaliz
- 1Department of Internal Medicine, King Hussein Cancer Center, 202 Queen Rania Al-Abdulla St., P.O. Box 1269, Amman, 11941 Jordan
| | - Yousef Ismael
- 5Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
152
|
Abstract
Introduction Cancer is an important risk factor for venous and arterial thromboembolic events. Treatment with chemotherapy was associated with a 6.5-fold increase in the risk of thromboembolic events. Here, we present a patient with cilioretinal artery emboli during cisplatin-based therapy. Case report A 54-year-old male patient with a diagnosis of metastatic small cell carcinoma was under cisplatin-based regimen. He presented with visual disturbance. Retinal fluorescein angiography showed multiple plaques located in cilioretinal artery and cilioretinal artery occlusion. After excluding other potential etiological factors, patient was diagnosed with cilioretinal artery occlusion associated with cisplatin. Discussion In oncology practice, patients are prone to thromboembolic events due to primary disease, underlying comorbidities and treatment modalities. In addition to numerous toxicities, cisplatin is an important risk factor for thromboembolic events. Clinicians caring patients with a diagnosis of cancer should be aware of this rare complication of cisplatin-based therapies.
Collapse
Affiliation(s)
- Ali Alkan
- Medical Oncology, Osmaniye Public Hospital, Osmaniye, Turkey
| | - Serap Talaz
- Ophthalmology, Osmaniye Public Hospital, Osmaniye, Turkey
| |
Collapse
|
153
|
Kayukawa S, Ina K, Furuta R, Nishio T, Miyashita T, Umeda S, Kataoka T. Bladder squamous cell cancer accompanied by Trousseau's syndrome: a case report. Clin Case Rep 2018; 6:653-657. [PMID: 29636934 PMCID: PMC5889235 DOI: 10.1002/ccr3.1433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 12/21/2022] Open
Abstract
The association between thrombosis and cancer has been recognized since Trousseau's report in 1865. We present a case of bladder squamous cell carcinoma associated with multiple cerebral infarctions. This patient was diagnosed as having Trousseau's syndrome and received radiotherapy for bladder cancer treatment, along with anticoagulation therapy.
Collapse
Affiliation(s)
- Satoshi Kayukawa
- Department of Clinical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Kenji Ina
- Department of Medical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Ryuichi Furuta
- Department of Medical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Tomoko Nishio
- Department of Pathology Nagoya Memorial Hospital Nagoya Japan
| | | | - Shun Umeda
- Department of Urology Nagoya Memorial Hospital Nagoya Japan
| | - Takae Kataoka
- Department of Clinical Oncology Nagoya Memorial Hospital Nagoya Japan
| |
Collapse
|
154
|
Sato C, Okuda K, Tamiya H, Yamamoto K, Hoshina K, Narumoto O, Urushiyama H, Noguchi S, Amano Y, Watanabe K, Mitani A, Kage H, Tanaka G, Yamauchi Y, Takai D, Nagase T. Acute Arterial Thrombosis during Postoperative Adjuvant Cisplatin-based Chemotherapy for Completely Resected Lung Adenocarcinoma. Intern Med 2018; 57:557-561. [PMID: 29225246 PMCID: PMC5849553 DOI: 10.2169/internalmedicine.8996-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A malignant tumor can cause hypercoagulation and it also often coexists with thrombosis. Cisplatin-based chemotherapy can also induce adverse vascular effects, including arterial thrombosis. We herein report a case of acute arterial thrombosis in a patient undergoing postoperative adjuvant cisplatin-based chemotherapy for completely resected lung cancer. The patient complained of acute leg pain after chemotherapy, and computed tomography revealed multiple thrombi from the thoracic to popliteal arteries. Arterial thrombosis during adjuvant chemotherapy is extremely rare; however, careful clinical observation of patients receiving cisplatin-based chemotherapy is important, because arterial thrombosis, even in the absence of the primary malignant tumor, is possible.
Collapse
Affiliation(s)
- Chihiro Sato
- General Education Center, The University of Tokyo Hospital, Japan
| | - Kenichi Okuda
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hiroyuki Tamiya
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kota Yamamoto
- Department of Vascular Surgery, The University of Tokyo Hospital, Japan
| | - Katsuyuki Hoshina
- Department of Vascular Surgery, The University of Tokyo Hospital, Japan
| | - Osamu Narumoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hirokazu Urushiyama
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoshi Noguchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yosuke Amano
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kosuke Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akihisa Mitani
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hidenori Kage
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Daiya Takai
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| |
Collapse
|
155
|
Nestler T, Huber J, Laury AM, Isbarn H, Heidenreich A, Schmelz HU, Ruf CG. Thromboprophylaxis and the route of administration of chemotherapy in testicular cancer patients in German-speaking countries. World J Urol 2018; 36:913-920. [PMID: 29417289 DOI: 10.1007/s00345-018-2222-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Due to the excellent cure rates for testicular cancer (TC), focus has shifted towards decreasing therapy-related morbidities. Thrombosis is a frequent complication of cisplatin chemotherapy. Furthermore, the optimal route of administration for chemotherapy is still under debate. The purpose of this study was to assess the patterns of care concerning dosing and duration of thromboprophylaxis currently utilized in TC patients in German-speaking countries as well as the route of chemotherapy administration. METHODS A standardized questionnaire was sent to all members of the German TC Study Group (GTCSG) and to all the urological university hospitals in Germany. The questionnaire was also sent to the oncologic clinics at those universities where urologists do not administer chemotherapy. RESULTS The response rate was 87% (55/63). Prophylactic anticoagulation with low-molecular-weight heparin (LMWH) was administered in 94% of the clinics. The dosing of LMWH was prophylactic (85%), high prophylactic (adjusted to bodyweight) (7%), or risk adapted (9%). After completion of chemotherapy, anticoagulation was continued in 15 clinics (33%) for 2 to 24 weeks, while the remainder stopped the LMWH upon cessation of chemotherapy. Chemotherapy was administered via central venous access in 59%, peripheral IV in 27%, or both in 14% of the clinics. CONCLUSIONS Most of the institutions performed some form of thromboprophylaxis, although the modes of application varied by institution type and amongst the urologists and oncologists. Prospective studies are needed to evaluate the incidence, date of occurrence, and risk factors of venous thrombosis during TC chemotherapy to provide a recommendation concerning prophylactic anticoagulation.
Collapse
Affiliation(s)
- Tim Nestler
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany. .,Department of Urology, University Hospital Cologne, Cologne, Germany.
| | - Johannes Huber
- Department of Urology, University Hospital Dresden, Dresden, Germany
| | - Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, Texas, USA
| | - Hendrik Isbarn
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Hans U Schmelz
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Christian G Ruf
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| |
Collapse
|
156
|
Risk prediction of cancer-associated thrombosis: Appraising the first decade and developing the future. Thromb Res 2018; 164 Suppl 1:S70-S76. [PMID: 29395243 DOI: 10.1016/j.thromres.2018.01.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/21/2022]
Abstract
Cancer-associated venous thromboembolism (VTE) has major consequences for patients, including morbidity and risk of mortality. However, there is substantial variation in risk depending on a multitude of clinical risk factors and many cancer patients are at low risk for VTE. This critical concept of risk variation has led to efforts to identify patients at high or low risk for developing VTE. Our research group and others have focused on understanding and predicting risk of cancer-associated VTE. This narrative review describe research efforts conducted over the past decade, beginning with the 2008 publication of the first validated risk assessment tool in this setting. We describe current applications of the "Khorana score" including identification of high- and low-risk patients, selecting and excluding patients for thromboprophylaxis and screening high-risk patients for early detection of VTE. New approaches to risk prediction including precision medicine and next-generation sequencing are discussed. Finally, we offer suggestions on improving the field of risk prediction in this setting in the near future.
Collapse
|
157
|
Voigtlaender M, Langer F. Management of cancer-associated venous thromboembolism - a case-based practical approach. VASA 2018; 47:77-89. [PMID: 29325495 DOI: 10.1024/0301-1526/a000684] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with solid tumours or haematological malignancies, venous thromboembolism (VTE) is a leading cause of death and significantly contributes to morbidity and healthcare resource utilization. Current practice guidelines recommend long-term anticoagulation with low-molecular-weight heparin (LMWH) as the treatment of choice for cancer-associated VTE, based on clinical trial data showing an overall improved safety and efficacy profile of LMWH compared to vitamin K antagonists. However, several open questions remain, e. g. with regard to the intensity and duration of LMWH therapy; moreover, recent real-world evidence indicates that adherence to parenteral anticoagulation with LMWH over the course of treatment is poor in clinical practice. In this regard, the direct oral factor Xa or thrombin inhibitors (DOACs) have emerged as potential alternatives in the management of patients with cancer-associated VTE, albeit findings from randomized controlled studies with a direct head-to-head comparison of DOACs with LMWH, the current standard of care, are still lacking. Based on the case of a lymphoma patient experiencing symptomatic pulmonary embolism during immunochemotherapy, this article aims at both highlighting the current state-of-the-art approach to cancer-associated VTE and pointing out some of the unresolved, controversial issues clinicians have to face when taking care of haematology and oncology patients with already established or with high risk of developing VTE. These issues include the management of patients with incidental pulmonary embolism or thrombocytopenia, the use of DOACs, and the initiation of pharmacological thromboprophylaxis in non-surgical cancer patients.
Collapse
|
158
|
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.
Collapse
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
| |
Collapse
|
159
|
Lee AYY. When can we stop anticoagulation in patients with cancer-associated thrombosis? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:128-135. [PMID: 29222247 PMCID: PMC6142616 DOI: 10.1182/asheducation-2017.1.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The optimal duration of anticoagulant therapy in patients with cancer-associated venous thromboembolism (VTE) is unknown. Without well-designed studies evaluating the efficacy, safety, and cost-effectiveness of continuing anticoagulant therapy beyond the acute treatment period of 3 to 6 months, evidence-based recommendations are lacking. Consensus guidelines generally suggest continuing anticoagulation treatment in patients with active cancer or receiving cancer treatment, with periodic reassessment of the risks and benefits. Unfortunately, with very little published data on the epidemiology of cancer-associated VTE beyond the initial 6 months, it is not possible for clinicians and patients to weigh risks and benefits in a quantitatively informed manner. Further research is needed to provide reliable and contemporary estimates on the risk of recurrent VTE off anticoagulant therapy, risk of bleeding on anticoagulant therapy, case fatality or all-cause mortality, and other important consequences of living with cancer-associated VTE. This chapter provides an overview of the published literature on real-world data on anticoagulant therapy use, the risks and risk factors of recurrent VTE and bleeding, and patient preference and values regarding long-term anticoagulation treatment. It will conclude with a pragmatic, experience-informed approach for tailoring anticoagulant therapy in patients with cancer-associated VTE.
Collapse
Affiliation(s)
- Agnes Y Y Lee
- Division of Hematology, University of British Columbia and British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| |
Collapse
|
160
|
When can we stop anticoagulation in patients with cancer-associated thrombosis? Blood 2017; 130:2484-2490. [PMID: 29212805 DOI: 10.1182/blood-2017-05-787929] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/27/2017] [Indexed: 01/08/2023] Open
Abstract
The optimal duration of anticoagulation in patients with cancer-associated venous thromboembolism (VTE) is unknown. Without well-designed studies evaluating the efficacy, safety and cost-effectiveness of continuing anticoagulant therapy beyond the acute treatment period of 3 to 6 months, evidence-based recommendations are lacking. Consensus guidelines generally suggest continuing anticoagulation in patients with active cancer or receiving cancer treatment, with periodic reassessment of the risks and benefits. Unfortunately, with very little published data on the epidemiology of cancer-associated VTE beyond the initial 6 months, it is not possible for clinicians and patients to weigh risks and benefits in a quantitatively informed manner. Further research is needed to provide reliable and contemporary estimates on the risk of recurrent VTE off anticoagulation, risk of bleeding on anticoagulation, case fatality or all-cause mortality, and other important consequences of living with cancer-associated VTE. This chapter provides an overview of the published literature on real-world data on anticoagulant therapy use, the risks and risk factors of recurrent VTE and bleeding, and patient preference and values regarding long-term anticoagulation. It will conclude with a pragmatic, experience-informed approach for tailoring anticoagulant therapy in patients with cancer-associated VTE.
Collapse
|
161
|
Rupa-Matysek J, Gil L, Kaźmierczak M, Barańska M, Komarnicki M. Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score. Med Oncol 2017; 35:5. [PMID: 29209847 PMCID: PMC5717131 DOI: 10.1007/s12032-017-1065-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023]
Abstract
The utility of the venous thromboembolism (VTE) risk assessment model known as the Khorana Risk Score (KRS) in patients with lymphoid malignancies receiving outpatient chemotherapy is not defined. We evaluated the association of the KRS with VTE in patients treated for diffuse large B cell lymphoma (DLBCL) or Hodgkin lymphoma (HL). Retrospective analyses were performed in 428 patients, 241 of whom were newly diagnosed with DLBCL and 187 of whom had HL. During the initial therapy, 64 (15%) patients developed VTE and 56 died during follow-up. More VTE events occurred in patients with DLBCL than in patients with HL. According to the KRS, 364 (85%) and 64 (15%) patients were considered to be at intermediate risk and high risk of VTE development, respectively. The high-risk KRS patients were more often diagnosed with HL than DLBCL (19 vs. 10%, P = 0.0143). The KRS did not discriminate between high- and intermediate-risk patients with respect to VTE occurrence (17 vs. 15%, P = 0.5868). In our patients, the KRS did not adequately predict VTE (positive predictive value 15%, negative predictive value 82% and C statistic 0.51). In the multivariate analysis, bulky disease (OR 2.34; 95% CI 1.62-3.36, P < 0.0001), poor prognostic disease (OR 1.32; 95% CI 1.01-1.74, P = 0.049) and DLBCL histological subtype (OR 1.61; 95% CI 1.17-2.19, P = 0.003) were all significantly associated with the VTE development. In this cohort of patients with lymphoid malignancies, the KRS did not adequately stratify or predict VTE events in patients at a higher risk of VTE. This finding suggests the need for the development of a disease-specific VTE assessment model.
Collapse
Affiliation(s)
- Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland.
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Maciej Kaźmierczak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Marta Barańska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Mieczysław Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| |
Collapse
|
162
|
Young JS, Simmons JW. Chemotherapeutic Medications and Their Emergent Complications. Hematol Oncol Clin North Am 2017; 31:995-1010. [DOI: 10.1016/j.hoc.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
163
|
Rapid occurrence of left ventricular thrombus associated with platinum-based chemotherapy plus cetuximab for the treatment of metastatic squamous cell carcinoma of the head and neck: A case report. Mol Clin Oncol 2017; 7:833-836. [PMID: 29181174 DOI: 10.3892/mco.2017.1393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/02/2017] [Indexed: 11/05/2022] Open
Abstract
Platinum-based chemotherapy plus cetuximab represents the first-line treatment for recurrent or metastatic squamous cell carcinoma of the head and neck. The most common adverse events associated with cetuximab are infusion reactions and skin reactions, and a risk of venous thromboembolic events has also recently been reported in association with cetuximab. It is well known that thrombosis is a common complication of malignancy, and represents the second most frequent cause of mortality in cancer patients. The present study reports the case of a 79-year-old man who presented with lung and liver metastases from tongue squamous cell carcinoma, for which platinum-based chemotherapy plus cetuximab was administered. After 1 cycle, the patient showed rapid growth of a left ventricular (LV) thrombus, despite ongoing antiplatelet therapy for an old myocardial infarction. Anticoagulant therapy was administered to treat the LV thrombus, which resolved within 1 week. To the best of our knowledge, this represents the first reported case of rapidly occurring LV thrombus associated with platinum-based chemotherapy plus cetuximab. Platinum-based chemotherapy plus cetuximab may be associated with a higher risk of embolic thrombus.
Collapse
|
164
|
Khosla S, Kennedy L, Abdulaal Y. Cisplatin induced acute mesenteric ischaemia: A case report and review of the literature. Int J Surg Case Rep 2017; 41:347-351. [PMID: 29145109 PMCID: PMC5686456 DOI: 10.1016/j.ijscr.2017.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022] Open
Abstract
Arterial thrombosis occurs in 2% of patients having Cisplatin-based chemotherapy. There is only one previous report detailing mesenteric ischaemia secondary to cisplatin. The mechanism relating to the development of arterial thrombosis is not understood. Benefit of prophylactic parenteral anticoagulation during cisplatin chemotherapy is unknown.
Introduction Cisplatin is a platinum-based chemotherapeutic agent, widely used in cancer therapies for numerous solid tumours. It is becoming more recognised that a potentially life-threatening complication of cisplatin is accelerated arterial and venous thrombosis. Presentation of case We describe a case of a 62 year-old with no risk factors for vascular disease who presented with thromboembolic acute mesenteric ischaemia of the small bowel during treatment with cisplatin for head and neck cancer. Discussion We review the literature on the incidence and pathogenesis of cisplatin induced arterial thrombosis and discuss current treatment options of acute mesenteric ischaemia detailing our management of this case. Conclusion Cisplatin increases the risk of arterial thrombosis and this case report details acute mesenteric ischaemia secondary to its use. We hope to raise clinician awareness of this sequelae which can occur even in patients in the absence of other identifiable risk factors.
Collapse
Affiliation(s)
- Shivun Khosla
- Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Tonbridge Road, Pembury, Kent, TN2 4QJ, United Kingdom.
| | - Lauren Kennedy
- Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Tonbridge Road, Pembury, Kent, TN2 4QJ, United Kingdom.
| | - Yasser Abdulaal
- Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Tonbridge Road, Pembury, Kent, TN2 4QJ, United Kingdom.
| |
Collapse
|
165
|
Using a novel computational drug-repositioning approach (DrugPredict) to rapidly identify potent drug candidates for cancer treatment. Oncogene 2017; 37:403-414. [PMID: 28967908 PMCID: PMC5799769 DOI: 10.1038/onc.2017.328] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 12/25/2022]
Abstract
Computation-based drug-repurposing/repositioning approaches can greatly speed up the traditional drug discovery process. To date, systematic and comprehensive computation-based approaches to identify and validate drug-repositioning candidates for epithelial ovarian cancer (EOC) have not been undertaken. Here, we present a novel drug discovery strategy that combines a computational drug-repositioning system (DrugPredict) with biological testing in cell lines in order to rapidly identify novel drug candidates for EOC. DrugPredict exploited unique repositioning opportunities rendered by a vast amount of disease genomics, phenomics, drug treatment, and genetic pathway and uniquely revealed that non-steroidal anti-inflammatories (NSAIDs) rank just as high as currently used ovarian cancer drugs. As epidemiological studies have reported decreased incidence of ovarian cancer associated with regular intake of NSAIDs, we assessed whether NSAIDs could have chemoadjuvant applications in EOC and found that (i) NSAID Indomethacin induces robust cell death in primary patient-derived platinum-sensitive and platinum- resistant ovarian cancer cells and ovarian cancer stem cells and (ii) downregulation of β-catenin is partially driving effects of Indomethacin in cisplatin-resistant cells. In summary, we demonstrate that DrugPredict represents an innovative computational drug- discovery strategy to uncover drugs that are routinely used for other indications that could be effective in treating various cancers, thus introducing a potentially rapid and cost-effective translational opportunity. As NSAIDs are already in routine use in gynecological treatment regimens and have acceptable safety profile, our results will provide with a rationale for testing NSAIDs as potential chemoadjuvants in EOC patient trials.
Collapse
|
166
|
Mechanisms and risk factors of thrombosis in cancer. Crit Rev Oncol Hematol 2017; 118:79-83. [DOI: 10.1016/j.critrevonc.2017.08.003] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/16/2017] [Indexed: 12/21/2022] Open
|
167
|
Kuderer NM, Poniewierski MS, Culakova E, Lyman GH, Khorana AA, Pabinger I, Agnelli G, Liebman HA, Vicaut E, Meyer G, Shepherd FA. Predictors of Venous Thromboembolism and Early Mortality in Lung Cancer: Results from a Global Prospective Study (CANTARISK). Oncologist 2017; 23:247-255. [PMID: 28951500 DOI: 10.1634/theoncologist.2017-0205] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/17/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with lung cancer are known to be at increased risk for venous thromboembolism (VTE). Venous thromboembolism is associated with increased risk for early mortality. However, there have been no studies performing a comprehensive assessment of risk factors for VTE or early mortality in lung cancer patients undergoing systemic chemotherapy in a global real-world setting. MATERIALS AND METHODS CANTARISK is a prospective, global, noninterventional cohort study including patients with lung cancer initiating a new cancer therapy. Clinical data were collected until 6-month follow-up. The impact of patient-, disease-, and treatment-related factors on the occurrence of VTE and early mortality was evaluated in univariable and multivariable Cox regression analyses. A previously validated VTE risk score (VTE-RS) was also calculated (also known as Khorana score). RESULTS Of 1,980 patients with lung cancer who were enrolled from 2011 to 2012, 84% had non-small cell lung cancer. During the first 6 months, 121 patients developed a VTE (6.1%), of which 47% had pulmonary embolism, 46% deep vein thrombosis, 3% catheter-associated thrombosis, and 4% visceral thrombosis. Independent predictors for VTE included female sex, North America location, leg immobilization, and presence of a central venous catheter. The VTE-RS was not significantly associated with VTE in either univariable or multivariable analysis in this population. During the study period, 472 patients died, representing 20%, 24%, 36%, and 25% with VTE-RS 1, 2, ≥3, or unknown, respectively (p < .0001). Significant independent predictors of early mortality include older age, current/former smoking, chronic obstructive pulmonary disease, Eastern Cooperative Oncology Group performance status ≥2, no prior surgery, and metastatic disease, as well as the VTE-RS. CONCLUSION In this global, prospective, real-world analysis, several demographic, geographic, and clinical factors are independent risk factors for VTE and early mortality in patients with lung cancer. The VTE-RS represents a significant independent predictor of early mortality but not for VTE in lung cancer in the era of targeted therapy. IMPLICATIONS FOR PRACTICE Multiple risk factors for both venous thromboembolism (VTE) and early mortality in patients with lung cancer receiving systemic chemotherapy should guide best practice by better informing clinical evaluation and treatment decision-making. The Khorana risk score is of value in assessing the risk of early all-cause mortality along with other clinical parameters in patients with lung cancer receiving systemic therapy. Further study is needed to fully evaluate the validity of the risk score in predicting the risk of VTE in the modern era of lung cancer therapy.
Collapse
Affiliation(s)
- Nicole M Kuderer
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marek S Poniewierski
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Eva Culakova
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alok A Khorana
- Department of Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ingrid Pabinger
- Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Agnelli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Howard A Liebman
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eric Vicaut
- Department of Medicine, Université Paris Descartes, Paris, France
| | - Guy Meyer
- Department of Medicine, Université Paris Descartes, Paris, France
| | - Frances A Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
168
|
Khorana AA, Vadhan-Raj S, Kuderer NM, Wun T, Liebman H, Soff G, Belani C, O'Reilly EM, McBane R, Eikelboom J, Damaraju CV, Beyers K, Dietrich F, Kakkar AK, Riess H, Peixoto RD, Lyman GH. Rivaroxaban for Preventing Venous Thromboembolism in High-Risk Ambulatory Patients with Cancer: Rationale and Design of the CASSINI Trial. Rationale and Design of the CASSINI Trial. Thromb Haemost 2017; 117:2135-2145. [PMID: 28933799 PMCID: PMC6328370 DOI: 10.1160/th17-03-0171] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) is a frequent complication of cancer associated with morbidity, mortality, increased hospitalizations and higher health care costs. Cancer patients at increased risk for VTE can be identified using a validated risk assessment score, and the incidence of VTE can be reduced in high-risk settings using anticoagulation. Rivaroxaban is a potent, oral, direct, factor Xa inhibitor approved for the prevention and treatment of thromboembolic events, including VTE. CASSINI is a double-blind, randomized, parallel-group, multicentre study comparing rivaroxaban with placebo in adult ambulatory patients with various cancers who are initiating systemic cancer therapy and are at high risk of VTE (Khorana score ≥ 2). Patients with primary brain tumours or those at risk for bleeding are excluded. Approximately 700 patients will be randomized 1:1 to rivaroxaban 10 mg daily or placebo for up to 6 months if there is no evidence of VTE from compression ultrasonography (CU) during screening or from routine care imaging within 30 days prior to randomization. Mandatory CU will also be performed at weeks 8 and 16 (±7 days), and at study end (±3 days). The primary efficacy hypothesis is that anticoagulation with rivaroxaban reduces the composite of objectively confirmed symptomatic or asymptomatic, lower-extremity, proximal deep-vein thrombosis (DVT); symptomatic, upper-extremity DVT; symptomatic or incidental pulmonary embolism; and VTE-related death compared with placebo. The primary safety objective is to assess major bleeding events (Clinical trial information: NCT02555878).
Collapse
Affiliation(s)
| | - Saroj Vadhan-Raj
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States
| | | | - Ted Wun
- University of California Davis Comprehensive Cancer Center, Sacramento, California, United States
| | - Howard Liebman
- University of Southern California Keck School of Medicine, Los Angeles, California, United States
| | - Gerald Soff
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Chandra Belani
- Penn State Hershey Cancer Institute, Hershey, Pennsylvania, United States
| | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | - C V Damaraju
- Janssen Research and Development, Raritan, New Jersey, United States
| | - Karen Beyers
- Janssen Research and Development, Raritan, New Jersey, United States
| | - Flavia Dietrich
- Janssen Research and Development, Raritan, New Jersey, United States
| | - Ajay K Kakkar
- University College London and Thrombosis Research Institute, London, United Kingdom
| | - Hanno Riess
- Charité University Hospitals, Berlin, Germany
| | - Renata D'Alpino Peixoto
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, United States
| |
Collapse
|
169
|
Precision cardio-oncology: understanding the cardiotoxicity of cancer therapy. NPJ Precis Oncol 2017; 1:31. [PMID: 29872712 PMCID: PMC5871905 DOI: 10.1038/s41698-017-0034-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/29/2017] [Accepted: 08/01/2017] [Indexed: 12/21/2022] Open
Abstract
Current oncologic treatments have brought a strong reduction in mortality in cancer patients. However, the cancer therapy-related cardiovascular complications, in particular chemo-therapy and radiation therapy-induced cardiotoxicities are a major cause of morbidity and mortality in people living with or surviving cancer. The simple fact is that all antineoplastic agents and radiation therapy target tumor cells but also result in collateral damage to other tissues including the cardiovascular system. The commonly used anthracycline chemotherapy agents can induce cardiomyopathy and congestive heart failure. Targeted therapies with human epidermal growth factor antibodies, tyrosine kinase inhibitors or vascular endothelial growth factor antibodies, and the antimetabolites also have shown to induce cardiomyopathy and myocardial ischemia. Cardiac arrhythmias and hypertension have been well described with the use of tyrosine kinase inhibitors and antimicrotubule agents. Pericarditis can happen with the use of cyclophosphamide or cytarabine. Mediastinal radiation can cause constrictive pericarditis, myocardial fibrosis, valvular lesions, and coronary artery disease. Despite significant progresses in the understanding of the molecular and pathophysiologic mechanisms behind the cardiovascular toxicity of cancer therapy, there is still lack of evidence-based approach for the monitoring and management of patients. This review will focus mainly on the recent advances in the molecular mechanisms of cardiotoxicity related to common cancer therapies while introducing the concept of cardio-oncology service. Applying the general principles of multi-disciplinary approaches toward the diagnosis, prevention, monitoring, and treatment of cancer therapy-induced cardiomyopathy and heart failure will also be discussed.
Collapse
|
170
|
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.
Collapse
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
| |
Collapse
|
171
|
Abstract
BACKGROUND The risk of arterial thromboembolism in patients with cancer is incompletely understood. OBJECTIVES The authors aimed to better define this epidemiological relationship, including the effects of cancer stage. METHODS Using the Surveillance Epidemiology and End Results-Medicare linked database, the authors identified patients with a new primary diagnosis of breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma from 2002 to 2011. They were individually matched by demographics and comorbidities to a Medicare enrollee without cancer, and each pair was followed through 2012. Validated diagnosis codes were used to identify arterial thromboembolism, defined as myocardial infarction or ischemic stroke. Cumulative incidence rates were calculated using competing risk survival statistics. Cox hazards analysis was used to compare rates between groups at discrete time points. RESULTS The authors identified 279,719 pairs of patients with cancer and matched control patients. The 6-month cumulative incidence of arterial thromboembolism was 4.7% (95% confidence interval [CI]: 4.6% to 4.8%) in patients with cancer compared with 2.2% (95% CI: 2.1% to 2.2%) in control patients (hazard ratio [HR]: 2.2; 95% CI: 2.1 to 2.3). The 6-month cumulative incidence of myocardial infarction was 2.0% (95% CI: 1.9% to 2.0%) in patients with cancer compared with 0.7% (95% CI: 0.6% to 0.7%) in control patients (HR: 2.9; 95% CI: 2.8 to 3.1). The 6-month cumulative incidence of ischemic stroke was 3.0% (95% CI: 2.9% to 3.1%) in patients with cancer compared with 1.6% (95% CI: 1.6% to 1.7%) in control patients (HR: 1.9; 95% CI: 1.8 to 2.0). Excess risk varied by cancer type (greatest for lung), correlated with cancer stage, and generally had resolved by 1 year. CONCLUSIONS Patients with incident cancer face a substantially increased short-term risk of arterial thromboembolism.
Collapse
|
172
|
Long-term cardiovascular complications in stage I seminoma patients. Clin Transl Oncol 2017; 19:1400-1408. [PMID: 28852960 PMCID: PMC5635068 DOI: 10.1007/s12094-017-1742-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/17/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The cure rate of stage I seminoma patients is close to 100% and so the recent focus of clinical research has shifted onto the prevention of treatment-related complications. We assessed long-term cardiovascular complications and identified risk factors for cardiovascular events (CVEs) in stage I seminoma patients. METHODS This retrospective cohort study included 406 consecutive stage I seminoma patients. Primary endpoint was CVE rate. RESULTS During a median follow-up of 8.6 years, we observed 23 CVEs in 406 patients [10-year CVE risk 5.6% (95% CI 3.2 to 8.8)]. In univariable competing risk analysis, higher age, positive smoking status, history of diabetes and hypertension were significantly associated with the occurrence of CVE. In multi-state analysis, new onset of diabetes, hypertension and hyperlipidemia during follow-up predicted for an excessively increased CVE risk. In multivariable analysis adjusting for age and smoking, the development of hypertension and hyperlipidemia after tumor-specific treatment prevailed as risk factors for CVE. Regarding adjuvant treatment modalities, patients receiving adjuvant radiotherapy had a significantly higher probability of CVE than patients receiving adjuvant carboplatin [16% vs. 0%; risk difference (RD) = 16%, 95% CI 6 to 25%, p = 0.001]. This difference prevailed after adjusting for age, follow-up-time, diabetes, hypertension and smoking (RD = 11%, 95% CI 1 to 20%, p = 0.025). CONCLUSION We identified a panel of baseline risk factors and dynamically, occurring predictors of CVE in stage I seminoma patients. This information may be used for targeting comorbidity management in these patients. The observed association of adjuvant radiotherapy with higher CVE risk warrants further investigation.
Collapse
|
173
|
Ramos JD, Wingate JT, Gulati R, Plimack ER, Harshman LC, Powles T, Crabb SJ, Niegisch G, Bellmunt J, Ladoire S, De Giorgi U, Hussain S, Alva AS, Baniel J, Agarwal N, Rosenberg JE, Vaishampayan UN, Galsky MD, Yu EY. Venous Thromboembolism Risk in Patients With Locoregional Urothelial Tract Tumors. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30242-2. [PMID: 28923700 PMCID: PMC5826750 DOI: 10.1016/j.clgc.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/05/2017] [Accepted: 08/13/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is common in cancer patients, but there is limited data on patients with urothelial tract tumors (UTT). We previously identified several associative factors for increased VTE rates in patients with metastatic UTT. In this study, we assessed the frequency, associative factors, and impact on survival of VTE in patients with locoregional UTT. METHODS Patients with locoregional bladder, upper urinary tract, or urethral cancer were included in this multi-center study from 29 academic institutions. Patients with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients with incomplete clinical staging or miscoded/missing data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis of muscle-invasive disease, excluding VTEs diagnosed in the metastatic setting. χ2 statistics tested differences in VTE rates across baseline and treatment-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Overall survival stratified by VTE was estimated using Kaplan-Meier methods and evaluated using the log-rank test. RESULTS A total of 1732 patients were eligible. There were 132 (7.6%) VTEs. On multivariate analysis, non-urothelial histology (P < .001), clinical Nx stage (P < .001), cardiovascular disease (P = .01), and renal dysfunction (P = .04) were statistically significant baseline factors associated with VTE. Using surgery alone as reference, surgery with perioperative chemotherapy (P = .04) and radiation with concurrent chemotherapy (P = .04) also were significant. CONCLUSIONS The VTE incidence of 7.6% in locoregional disease is comparable with our previously reported rate in the metastatic setting (8.2%). Similar to our findings in metastatic UTT, non-urothelial histology, renal dysfunction, and CVD was associated with increased VTE risk.
Collapse
Affiliation(s)
- Jorge D Ramos
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Roman Gulati
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Thomas Powles
- Barts and the London School of Medicine, London, England
| | | | - Guenter Niegisch
- Medical Faculty, Department of Urology, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Sylvain Ladoire
- Georges François Leclerc Center, Dijon, France; Université de Bourgogne, Dijon, France
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | | | | | | | - Evan Y Yu
- University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
| |
Collapse
|
174
|
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.
Collapse
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
| |
Collapse
|
175
|
Liu B, Ding F, Zhang D, Wei GH. Risk of venous and arterial thromboembolic events associated with VEGFR-TKIs: a meta-analysis. Cancer Chemother Pharmacol 2017; 80:487-495. [PMID: 28695268 DOI: 10.1007/s00280-017-3386-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
The reported incidence of arterial and venous thromboembolic events varies markedly between VEGFR-TKI-related clinical trials. Here, we performed a meta-analysis to determine the incidence and the relative risk (RR) of venous thromboembolism events (VTEs) and arterial thromboembolic events (ATEs) associated with these agents. Databases (PubMed, Web of Science) were searched for relevant studies. Statistical analyses were conducted to calculate the summary incidences, RRs and 95% confidence intervals (CIs) using either random-effects or fixed-effects models according to the heterogeneity of the included studies. A total of 24,855 patients from 48 studies were included. The overall incidence of all-grade and high-grade VTEs associated with VEGFR-TKIs was 3.6% (95% CI 2.3-5.2%) and 1.6% (95% CI 1.0-2.4%), respectively. The use of VEGFR-TKIs did not significantly increase the risk of developing all-grade (RR 0.91; 95% CI 0.68-1.22; P = 0.558) and high-grade (RR 1.05; 95% CI 0.84-1.31; P = 0.769) VTEs. The overall incidence of all-grade and high-grade ATEs associated with VEGFR-TKIs was 2.7% (95% CI 1.7-3.6%) and 0.6% (95% CI 0.2-1.2%), respectively. The use of VEGFR-TKIs significantly increase the risk of developing all-grade (RR 3.09; 95% CI 1.41-6.76; P = 0.033) ATEs, and a tendency to increase the risk of high-grade (RR 1.49; 95% CI 0.99-2.24; P = 0.101) ATEs was also detected. Patients with cancer that receive VEGFR-TKIs are at high risk of developing ATEs. Physicians should be aware of these adverse effects and should monitor cancer patients receiving VEGFR-TKIs.
Collapse
Affiliation(s)
- Bo Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, 400014, China
| | - Fengxia Ding
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, No. 136, Zhongshan 2 RD, Yuzhong District, Chongqing, 400014, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, 400014, China.
| | - Deying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, 400014, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| |
Collapse
|
176
|
Ageno W, Mantovani LG, Haas S, Kreutz R, Monje D, Schneider J, van Eickels M, Gebel M, Turpie AGG. Subgroup Analysis of Patients with Cancer in XALIA: A Noninterventional Study of Rivaroxaban versus Standard Anticoagulation for VTE. TH OPEN 2017; 1:e33-e42. [PMID: 31259294 PMCID: PMC6598195 DOI: 10.1055/s-0037-1603924] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background
The noninterventional XALIA study compared rivaroxaban with standard anticoagulation for deep vein thrombosis treatment. This substudy describes the demographics, clinical characteristics, and outcomes of the patients with cancer.
Methods
Therapy type, dose, and duration were at the physician's discretion. The cohorts identified were rivaroxaban (rivaroxaban alone or after heparin or fondaparinux for ≤48 hours); early switchers (rivaroxaban after heparin or fondaparinux for >48 hours to 14 days and/or a vitamin K antagonist [VKA] for 1–14 days); standard anticoagulation (heparin or fondaparinux and a VKA); low-molecular-weight heparin (LMWH) alone; and miscellaneous (other heparins, fondaparinux alone, VKA alone). Primary outcomes were major bleeding, recurrent venous thromboembolism, and all-cause mortality.
Results
In XALIA, 587 patients (11.4% of the XALIA cohort) were with cancer: 146 (24.9%) rivaroxaban, 30 (5.1%) early switchers, 141 (24.0%) standard anticoagulation, 223 (38.0%) LMWH, and 47 (8.0%) miscellaneous. Patients with gastrointestinal or lung cancer more commonly received LMWH than rivaroxaban; the opposite occurred in patients with breast or genitourinary cancer. Rates of primary outcome in the rivaroxaban group were as follows: major bleeding, 1.4% (
n
= 2); recurrent venous thromboembolism, 3.4% (
n
= 5); and all-cause mortality, 4.8% (
n
= 7).
Conclusion
In XALIA, physicians treated cancer-associated thrombosis with various anticoagulant regimens, most commonly LMWH. In addition, the choice of anticoagulant varied with cancer type. In rivaroxaban-treated patients, rates for the primary outcomes were low, suggesting that patients administered rivaroxaban were a good prognosis group.
Collapse
Affiliation(s)
- Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Lorenzo G Mantovani
- CESP-Center for Public Health Research, University of Milan Bicocca, Monza, Italy
| | - Sylvia Haas
- Technical University of Munich, Munich, Germany
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
177
|
Fradley MG, Brown AC, Shields B, Viganego F, Damrongwatanasuk R, Patel AA, Hartlage G, Roper N, Jaunese J, Roy L, Ismail-Khan R. Developing a Comprehensive Cardio-Oncology Program at a Cancer Institute: The Moffitt Cancer Center Experience. Oncol Rev 2017; 11:340. [PMID: 28781723 PMCID: PMC5523022 DOI: 10.4081/oncol.2017.340] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/24/2022] Open
Abstract
Cardio-oncology is a multidisciplinary field focusing on the management and prevention of cardiovascular complications in cancer patients and survivors. While the initial focus of this specialty was on heart failure associated with anthracycline use, novel anticancer agents are increasingly utilized and are associated with many other cardiotoxicities including hypertension, arrhythmias and vascular disease. Since its inception, the field has developed at a rapid pace with the establishment of programs at many major academic institutions and community practices. Given the complexities of this patient population, it is important for providers to possess knowledge of not only cardiovascular disease but also cancer subtypes and their specific therapeutics. Developing a cardio-oncology program at a stand-alone cancer center can present unique opportunities and challenges when compared to those affiliated with other institutions including resource allocation, cardiovascular testing availability and provider education. In this review, we present our experiences establishing the cardio-oncology program at Moffitt Cancer Center and provide guidance to those individuals interested in developing a program at a similar independent cancer institution.
Collapse
Affiliation(s)
- Michael G. Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Allen C. Brown
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Bernadette Shields
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Federico Viganego
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Rongras Damrongwatanasuk
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Aarti A. Patel
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Gregory Hartlage
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Natalee Roper
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julie Jaunese
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Larry Roy
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Women’s Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
178
|
Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Pabinger I, Solymoss S, Douketis J, Kakkar A. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 2017; 17:e452-e466. [PMID: 27733271 DOI: 10.1016/s1470-2045(16)30369-2] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 02/07/2023]
Abstract
Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specific subgroups of patients with cancer.
Collapse
Affiliation(s)
- Dominique Farge
- Assistance Publique-Hôpitaux de Paris, Internal Medicine: Autoimmune and Vascular Disease Unit, Saint-Louis Hospital, Paris, France; Sorbonne Paris Cité, Paris 7 Diderot University, Paris, France.
| | - Henri Bounameaux
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Francis Cajfinger
- Assistance Publique-Hôpitaux de Paris, Service d'oncologie, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Alok A Khorana
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
| | - Susan Solymoss
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ajay Kakkar
- Thrombosis Research Institute, London, UK; University College London, London, UK
| |
Collapse
|
179
|
Gerotziafas GT, Taher A, Abdel-Razeq H, AboElnazar E, Spyropoulos AC, El Shemmari S, Larsen AK, Elalamy I. A Predictive Score for Thrombosis Associated with Breast, Colorectal, Lung, or Ovarian Cancer: The Prospective COMPASS-Cancer-Associated Thrombosis Study. Oncologist 2017; 22:1222-1231. [PMID: 28550032 PMCID: PMC5634762 DOI: 10.1634/theoncologist.2016-0414] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
The COMPASS‐CAT study was undertaken in outpatients with breast, colon, lung, or ovarian cancer. The aim of the study was to identify the most relevat risk factors for symptomatic thromboembolism and to develop a risk assessment model applicable to patients after the initiation of anticancer treatment. Background. The stratification of outpatients on chemotherapy for breast, colorectal, lung, and ovarian cancers at risk of venous thromboembolism (VTE) remains an unmet clinical need. The derivation of a risk assessment model (RAM) for VTE in these patients was the aim of the study “Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients–Cancer Associated Thrombosis” (COMPASS–CAT). Patients and Methods. The derivation cohort consisted of 1,023 outpatients. Patients on low molecular weight heparin (LMWH) thromboprophylaxis were excluded. Documented symptomatic VTE was the endpoint of the study. Results. Patients had breast (61%), colorectal (17%), lung (13%), or ovarian cancer (8.6%) at localized (30%) or advanced stage (70%). In 64% of patients, cancer was diagnosed within the last 6 months prior to inclusion. Most of them were on chemotherapy when assessed. Symptomatic VTE occurred in 8.5% of patients. The COMPASS–CAT RAM includes the following variables: (a) anthracycline or anti‐hormonal therapy, (b) time since cancer diagnosis, (c) central venous catheter, (d) stage of cancer, (e) presence of cardiovascular risk factors, (f) recent hospitalization for acute medical illness, (g) personal history of VTE, and (h) platelet count. At 6 months, patients stratified at low/intermediate and high‐risk groups had VTE rates of 1.7% and 13.3%, respectively. The area under the curve of receiver operating characteristics analysis was 0.85. The sensitivity and specificity of the RAM were 88% and 52%, respectively. The negative and positive predictive values of the RAM were 98% and 13%, respectively. Conclusion. The COMPASS–CAT RAM includes reliable and easily collected VTE risk predictors and, in contrast to the Khorana score, it is applicable after the initiation of anticancer treatment in patients with common solid tumors. Its robustness for stratification of patients at high and low/intermediate VTE risk needs to be externally validated. Implications for Practice. The Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients–Cancer Associated Thrombosis (COMPASS–CAT) study provides a new risk assessment model (RAM) for venous thromboembolism (VTE) applicable in outpatients with breast, colorectal, lung or ovarian cancer. The COMPASS–CAT RAM is robust, applicable during chemotherapy and determines the need for VTE prévention by including reliable and easily collected VTE predictors associated with cancer status, its treatment as well as with patients' characteristics and comorbidities. An independent external validation of the RAM is indicated before its use in clinical practice.
Collapse
Affiliation(s)
- Grigoris T Gerotziafas
- Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
- Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Ali Taher
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Lebanon
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Alex C Spyropoulos
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, New York, USA
| | - Salem El Shemmari
- Department of Medical Oncology, Kuwait Cancer Control Center, Kuwait City, Kuwait
| | - Annette K Larsen
- Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
| | - Ismail Elalamy
- Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
- Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France
| |
Collapse
|
180
|
Hurtado-de-Mendoza D, Loaiza-Bonilla A, Bonilla-Reyes PA, Tinoco G, Alcorta R. Cardio-Oncology: Cancer Therapy-related Cardiovascular Complications in a Molecular Targeted Era: New Concepts and Perspectives. Cureus 2017; 9:e1258. [PMID: 28649481 PMCID: PMC5473719 DOI: 10.7759/cureus.1258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 05/17/2017] [Indexed: 12/13/2022] Open
Abstract
Cardio-oncology is a medical discipline that identifies, prevents, and treats the cardiovascular complications related to cancer therapy. Due to the remarkable proliferation of new cancer therapies causing cardiovascular complications, such as hypertension, heart failure, vascular complications, and cardiac arrhythmia, we provide an extensive, comprehensive revision of the most up-to-date scientific information available on the cardiovascular complications associated with the use of newer, novel chemotherapeutic agents, including their reported incidence, suggested pathophysiology, clinical manifestations, potential treatment, and prevention. The authors consider this topic to be relevant for the clinicians since cardiovascular complications associated with the administration of recently approved drugs are relatively underappreciated. The purpose of this article is to provide a state-of-the-art review of cardiovascular complications associated with the use of newer, novel chemotherapeutic agents and targeted therapies, including their reported incidence, suggested pathophysiology, clinical manifestations, potential treatment, and prevention. Ongoing efforts are needed to provide a better understanding of the frequency, mechanisms of disease, prevention, and treatment of cardiovascular complications induced by the newer, novel chemotherapeutic agents. Development of a cardio-oncology discipline is warranted in order to promote task forces aimed at the creation of oncology patient-centered guidelines for the detection, prevention, and treatment of potential cardiovascular side effects associated with newer cancer therapies.
Collapse
Affiliation(s)
- David Hurtado-de-Mendoza
- University of Miami Miller School of Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Florida, USA
| | | | | | - Gabriel Tinoco
- Department of Internal Medicine, The Ohio State University College of Medicine
| | | |
Collapse
|
181
|
Bezan A, Posch F, Ploner F, Bauernhofer T, Pichler M, Szkandera J, Hutterer GC, Pummer K, Gary T, Samonigg H, Beyer J, Winder T, Hermanns T, Fankhauser CD, Gerger A, Stotz M. Risk stratification for venous thromboembolism in patients with testicular germ cell tumors. PLoS One 2017; 12:e0176283. [PMID: 28430804 PMCID: PMC5400272 DOI: 10.1371/journal.pone.0176283] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Patients with testicular germ cell tumors (TGCT) have an increased risk for venous thromboembolism (VTE). We identified risk factors for VTE in this patient cohort and developed a clinical risk model. Methods In this retrospective cohort study at the Medical University of Graz we included 657 consecutive TGCT patients across all clinical stages. A predictive model for VTE was developed and externally validated in 349 TGCT patients treated at the University Hospital Zurich. Results Venous thromboembolic events occurred in 34 (5.2%) patients in the Graz cohort. In univariable competing risk analysis, higher clinical stage (cS) and a retroperitoneal lymphadenopathy (RPLN) were the strongest predictors of VTE (p<0.0001). As the presence of a RPLN with more than 5cm in greatest dimension without coexisting visceral metastases is classified as cS IIC, we constructed an empirical VTE risk model with the following four categories (12-month-cumulative incidence): cS IA-B 8/463 patients (1.7%), cS IS-IIB 5/86 patients (5.9%), cS IIC 3/21 patients (14.3%) and cS IIIA-C 15/70 patients (21.4%). This risk model was externally validated in the Zurich cohort (12-month-cumulative incidence): cS IA-B (0.5%), cS IS-IIB (6.0%), cS IIC (11.1%) and cS IIIA-C (19.1%). Our model had a significantly higher discriminatory performance than a previously published classifier (RPLN-VTE-risk-classifier) which is based on the size of RPLN alone (AUC-ROC: 0.75 vs. 0.63, p = 0.007). Conclusions According to our risk stratification, TGCT patients with cS IIC and cS III disease have a very high risk of VTE and may benefit from primary thromboprophylaxis for the duration of chemotherapy.
Collapse
Affiliation(s)
- Angelika Bezan
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
| | - Florian Posch
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
| | - Ferdinand Ploner
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Bauernhofer
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Martin Pichler
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Department of Experimental Therapeutics, The University of Texas, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Karl Pummer
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Hellmut Samonigg
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Joerg Beyer
- Department of Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas Winder
- Department of Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Christian D. Fankhauser
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
- * E-mail: (CDF); (AG)
| | - Armin Gerger
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- * E-mail: (CDF); (AG)
| | - Michael Stotz
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Research Unit Genetic Epidemiology and Pharmacogenetics, Medical University of Graz, Graz, Austria
| |
Collapse
|
182
|
Cella CA, Di Minno G, Carlomagno C, Arcopinto M, Cerbone AM, Matano E, Tufano A, Lordick F, De Simone B, Muehlberg KS, Bruzzese D, Attademo L, Arturo C, Sodano M, Moretto R, La Fata E, De Placido S. Preventing Venous Thromboembolism in Ambulatory Cancer Patients: The ONKOTEV Study. Oncologist 2017; 22:601-608. [PMID: 28424324 DOI: 10.1634/theoncologist.2016-0246] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/20/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The efficacy of risk model scores to predict venous thromboembolism (VTE) in ambulatory cancer patients is under investigation, aiming to stratify on an individual risk basis the subset of the cancer population that could mostly benefit from primary thromboprophylaxis. MATERIALS AND METHODS We prospectively assessed 843 patients with active cancers, collecting clinical and laboratory data. We screened all the patients with a duplex ultrasound (B-mode imaging and Doppler waveform analysis) of the upper and lower limbs to evaluate the right incidence of VTE (both asymptomatic and symptomatic). The efficacy of the existing Khorana risk model in preventing VTE was also explored in our population. Several risk factors associated with VTE were analyzed, leading to the construction of a risk model. The Fine and Gray model was used to account for death as a competing risk in the derivation of the new model. RESULTS The risk factors significantly associated with VTE at univariate analysis and further confirmed in the multivariate analysis, after bootstrap validation, were the presence of metastatic disease, the compression of vascular/lymphatic structures by tumor, a history of previous VTE, and a Khorana score >2. Time-dependent receiving operating characteristic (ROC) curve analysis showed a significant improvement in the area under the curve of the new score over the Khorana model at 3 months (71.9% vs. 57.9%, p = .001), 6 months (75.4% vs. 58.6%, p < .001), and 12 months (69.8% vs. 58.3%, p = .014). CONCLUSION ONKOTEV score steps into history of cancer-related-VTE as a promising tool to drive the decision about primary prophylaxis in cancer outpatients. The validation represents the goal of the prospective ONKOTEV-2 study, endorsed and approved by the European Organization for Research and Treatment of Cancer Young Investigators Program. The Oncologist 2017;22:601-608 IMPLICATIONS FOR PRACTICE: Preventing venous thromboembolism in cancer outpatients with a risk model score will drive physicians' decision of starting thromboprophylaxis in high-risk patients.
Collapse
Affiliation(s)
- Chiara Alessandra Cella
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
- University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Chiara Carlomagno
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Michele Arcopinto
- Heart Surgery Department, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medicine, Leipzig, Germany
| | - Biagio De Simone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Laura Attademo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Arturo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marta Sodano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Roberto Moretto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ersilia La Fata
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| |
Collapse
|
183
|
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.
Collapse
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.
| |
Collapse
|
184
|
Khorana AA, Francis CW, Kuderer NM, Carrier M, Ortel TL, Wun T, Rubens D, Hobbs S, Iyer R, Peterson D, Baran A, Kaproth-Joslin K, Lyman GH. Dalteparin thromboprophylaxis in cancer patients at high risk for venous thromboembolism: A randomized trial. Thromb Res 2017; 151:89-95. [DOI: 10.1016/j.thromres.2017.01.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/21/2016] [Accepted: 01/25/2017] [Indexed: 12/21/2022]
|
185
|
Gonzalez-Billalabeitia E, Castellano D, Sobrevilla N, Guma J, Hervas D, Luengo MI, Aparicio J, Sanchez-Muñoz A, Mellado B, Saenz A, Valverde C, Fernandez A, Margeli M, Duran I, Fernandez S, Sastre J, Ros S, Maroto P, Manneh R, Cerezuela P, Carmona-Bayonas A, Ayala de la Peña F, Luis Aguilar J, Rivera S, García Del Muro X, Germà-Lluch JR. Prognostic Significance of Venous Thromboembolic Events in Disseminated Germ Cell Cancer Patients. J Natl Cancer Inst 2017; 109:2957313. [PMID: 28122896 DOI: 10.1093/jnci/djw265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/26/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022] Open
Abstract
Background Disseminated germ cell cancers are at high risk of developing thromboembolic complications. We evaluated the prognostic value of venous thromboembolic events (VTE) in disseminated germ cell cancer. Methods Patients with germ cell cancer receiving upfront platinum-containing chemotherapy between 2004 and 2014 were pooled from the Spanish Germ Cell Cancer Group (SGCCG) registry and reviewed for the presence of VTE. Results were validated in an independent international group of patients. We used a penalized Cox proportional hazards model including VTE as a time-varying covariate to identify and validate prognostic factors. All statistical tests were two-sided. Results The SGCCG registry identified 416 patients from 14 referral institutions. With a median follow-up of 49 months, VTEs were observed in 9% of patients (n = 38). Events occurred at diagnosis, during chemotherapy, and after chemotherapy in 2.6%, 5.0%, and 1.4% of patients, respectively. VTE was associated with shorter progression-free survival (PFS; hazard ratio [HR] = 2.29, 95% confidence interval [CI] = 1.18 to 4.47, P = .02) and overall survival (OS; HR = 5.14, 95% CI = 2.22 to 11.88, P < .001). In multivariable analysis, the effect was consistent in the intermediate-risk group, both for PFS (HR = 9.52 95% CI = 2.48 to 36.58, P < .001) and OS (HR = 12.84, 95% CI = 2.01 to 82.02, P = .007). VTE at diagnosis is also an adverse prognostic variable for progression-free survival (HR = 4.64, 95% CI = 2.04 to 10.54, P < .001) and for overall survival (HR = 6.28, 95% CI = 1.68 to 17.10, P = .01). These results were validated in an independent international cohort that included 241 patients from four hospitals. Conclusions VTE is an independent adverse prognostic factor in disseminated germ cell cancers, in particular for the intermediate prognostic group of the International Germ Cell Cancer Collaborative Group classification. The presence of VTE at diagnosis has also prognostic significance and should be further explored in future prognostic classifications.
Collapse
Affiliation(s)
- Enrique Gonzalez-Billalabeitia
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Daniel Castellano
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Nora Sobrevilla
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Josep Guma
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - David Hervas
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Maria I Luengo
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jorge Aparicio
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alfonso Sanchez-Muñoz
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Begoña Mellado
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alberto Saenz
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Claudia Valverde
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Antonio Fernandez
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Mireia Margeli
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Ignacio Duran
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Sara Fernandez
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Javier Sastre
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Silverio Ros
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Pablo Maroto
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Ray Manneh
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Pablo Cerezuela
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Alberto Carmona-Bayonas
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Francisco Ayala de la Peña
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jose Luis Aguilar
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Samuel Rivera
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Xavier García Del Muro
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | - Jose R Germà-Lluch
- Affiliations of authors: Hospital Universitario Morales Meseguer-IMIB, Murcia, Spain (EGB, MIL, ACB, FAdlP); Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain (EGB); Hospital Universitario 12 de Octubre, Madrid, Spain (DC, RM); Instituto Nacional de Cancerología, Mexico DF, Mexico (NS, JLA); Hospital San Joan de Reus, IISSPV, URV, Spain (JG); Instituto de Investigación Sanitaria La Fe, Valencia, Spain (DH); Hospital Universitario La Fe, Valencia, Spain (JA); Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria de Málaga, Málaga, Spain (ASM); Servicio de Oncología Médica, Hospital Clinic, IDIBAPS, Barcelona, Spain (BM); Hospital Clinico Lozano Blesa, Zaragoza, Spain (AS); Hospital Universitario Vall d'Hebron, Barcelona, Spain (CV); Complejo Hospitalario Universitario de Albacete, Albacete, Spain (AF); Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Badalona, Spain (MM); Hospital Universitario Virgen del Rocío, Sevilla, Spain (ID); Hospital Central de Asturias, Oviedo, Spain (SF); Hospital Clínico San Carlos, Madrid, Spain (JS); Hospital Virgen de la Arrixaca, Murcia, Spain (SRo); Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (PM); Hospital Santa Lucía, Cartagena, Spain (PC); Hospital de Oncología, Centro Médico Nacional SXXI, México DF, México (SRi); Institut Catala d'Oncologia, Barcelona, Spain (XGdM, JRGL)
| | | |
Collapse
|
186
|
Zahir MN, Shaikh Q, Shabbir-Moosajee M, Jabbar AA. Incidence of Venous Thromboembolism in cancer patients treated with Cisplatin based chemotherapy - a cohort study. BMC Cancer 2017; 17:57. [PMID: 28093087 PMCID: PMC5238519 DOI: 10.1186/s12885-016-3032-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 12/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents. Methods Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed group while 200 patients who had received non-Cisplatin based regimens were identified as the non-exposed group. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Cox proportional hazard model was used to compute relative risks with 95% confidence intervals. Results The baseline characteristics were similar in the two groups. Mean age for the entire cohort was 55.4 ± 10.7 years and male to female ratio was almost 1:1. On univariate analysis, cisplatin based chemotherapy, presence of central venous catheter, female gender, poor performance status, high risk stratification according to the Khorana model and use of granulocyte colony stimulating factor were all significantly associated with the development of VTE. The crude relative risk for the incidence of VTE in cisplatin group was 2.8 (95% CI, 1.4 – 4.2) times compared to the non-Cisplatin group. When the relative risk was adjusted for the above variables in multivariable analysis, it increased to 3.3 (95% CI, 1.6 – 6.8) compared to the control group. Conclusion A high incidence of VTE in patients receiving cisplatin based chemotherapy was demonstrated in this study. Prospective studies are warranted to establish this observation with certainty and to explore the possible use of thromboprophylaxis in patients receiving cisplatin based chemotherapeutic regimens.
Collapse
Affiliation(s)
- Muhammad Nauman Zahir
- Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan.
| | - Quratulain Shaikh
- Department of Medicine, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan
| | - Munira Shabbir-Moosajee
- Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan
| | - Adnan Abdul Jabbar
- Department of Oncology, Aga Khan University Hospital, Stadium Road, PO BOX: 3500, Karachi, 74800, Pakistan
| |
Collapse
|
187
|
Ramos JD, Casey MF, Crabb SJ, Bamias A, Harshman LC, Wong YN, Bellmunt J, De Giorgi U, Ladoire S, Powles T, Pal SK, Niegisch G, Recine F, Alva A, Agarwal N, Necchi A, Vaishampayan UN, Rosenberg JE, Galsky MD, Yu EY. Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival. Cancer Med 2016; 6:186-194. [PMID: 28000388 PMCID: PMC5269690 DOI: 10.1002/cam4.986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/27/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022] Open
Abstract
Venous thromboembolism (VTE) is common in cancer patients. However, little is known about VTE risk in metastatic urothelial carcinoma or variant histologies (UC/VH). We sought to characterize the incidence, associative factors, including whether various chemotherapy regimens portend different risk, and impact of VTE on survival in metastatic UC/VH patients. Patients diagnosed with metastatic UC/VH from 2000 to 2013 were included in this multicenter retrospective, international study from 29 academic institutions. Cumulative and 6‐month VTE incidence rates were determined. The association of first‐line chemotherapy (divided into six groups) and other baseline characteristics on VTE were analyzed. Each chemotherapy treatment group and statistically significant baseline clinical characteristics were assessed in a multivariate, competing‐risk regression model. VTE patients were matched to non‐VTE patients to determine the impact of VTE on overall survival. In all, 1762 patients were eligible for analysis. There were 144 (8.2%) and 90 (5.1%) events cumulative and within the first 6 months, respectively. VTE rates based on chemotherapy group demonstrated no statistical difference when gemcitabine/cisplatin was used as the comparator. Non‐urotheilal histology (SHR: 2.67; 95% CI: 1.72–4.16, P < 0.001), moderate to severe renal dysfunction (SHR: 2.12; 95% CI: 1.26–3.59, P = 0.005), and cardiovascular disease (CVD) or CVD risk factors (SHR: 2.27; 95% CI: 1.49–3.45, P = 0.001) were associated with increased VTE rates. Overall survival was worse in patients with VTE (median 6.0 m vs. 10.2 m, P < 0.001). Thus, in metastatic UC/VH patients, VTE is common and has a negative impact on survival. We identified multiple associated potential risk factors, although different chemotherapy regimens did not alter risk.
Collapse
Affiliation(s)
| | - Martin F Casey
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Yu-Ning Wong
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sylvain Ladoire
- Georges François Leclerc Center, Dijon, France.,Université de Bourgogne, Dijon, France
| | - Thomas Powles
- Barts and the London School of Medicine, London, England
| | | | | | - Federica Recine
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ajjai Alva
- University of Michigan, Ann Arbor, Michigan
| | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Evan Y Yu
- University of Washington, Seattle, Washington
| | | |
Collapse
|
188
|
Ay C, Pabinger I, Cohen AT. Cancer-associated venous thromboembolism: Burden, mechanisms, and management. Thromb Haemost 2016; 117:219-230. [PMID: 27882374 DOI: 10.1160/th16-08-0615] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 10/28/2016] [Indexed: 11/05/2022]
Abstract
Venous thromboembolism (VTE) is a significant health problem in the general population but especially in cancer patients. In this review, we discuss the epidemiology and burden of the disease, the pathophysiology of cancer-associated VTE, and the clinical treatment options for both primary prevention and acute treatment. Overall, the development of VTE in cancer patients is related to increases in morbidity, mortality, and medical costs. However, the incidence of cancer-associated VTE varies due to patient-related factors (e.g. thrombophilia, comorbidities, performance status, history of venous diseases), tumour-related factors (e.g. cancer site, stage, grade), and treatment-related factors (e.g. surgery, chemotherapy, anti-angiogenesis treatment, hormonal and supportive treatment). Furthermore, blood count parameters (e.g. platelets and leukocytes) and biomarkers (e.g. soluble P-selectin and D-dimer) are predictive markers for the risk of VTE in cancer patients and have been used to enhance risk stratification. Evidence suggests that cancer itself is associated with a state of hypercoagulability, driven in part by the release of procoagulant factors, such as tissue factor, from malignant tissue as well as by inflammation-driven activation of endothelial cells, platelets, and leukocytes. In general, low-molecular-weight heparin (LWMH) monotherapy is the standard of care for the management of cancer-associated VTE, as vitamin K antagonists are less effective in cancer patients. Direct oral anticoagulants (DOACs) offer a potentially promising treatment option for cancer patients with VTE, but recommendations concerning the routine use of DOACs should await head-to-head studies with LMWH.
Collapse
Affiliation(s)
- Cihan Ay
- Dr. Cihan Ay, MD, Medical University of Vienna, Department of Medicine I,, Clinical Division of Haematology and Haemostaseology, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Tel.: +43 1 40400 44100, Fax: +43 1 40400 40300, E-mail:
| | | | | |
Collapse
|
189
|
Alexander ET, Minton AR, Hayes CS, Goss A, Van Ryn J, Gilmour SK. Thrombin inhibition and cyclophosphamide synergistically block tumor progression and metastasis. Cancer Biol Ther 2016; 16:1802-11. [PMID: 26383051 DOI: 10.1080/15384047.2015.1078025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Cancer is often associated with an increased risk of thrombotic events which are exacerbated by treatment with chemotherapeutics such as cyclosphosphamide (CP). Evidence suggests that thrombin can stimulate tumor progression via formation of fibrin and activation of protease-activated receptors (PARs) and platelets. We examined the effect of co-treatment with CP and dabigatran etexilate, a direct inhibitor of thrombin, using the murine orthotopic 4T1 tumor model. Mice receiving co-treatment with both low dose CP and dabigatran etexilate had significantly smaller mammary tumors and fewer lung metastases than mice treated with CP or dabigratran etexilate alone. Co-treatment with dabigatran etexilate and low dose CP also significantly decreased the number of arginase(+)Gr-1(+)CD11b(+) myeloid derived suppressor cells as well as levels of TGF-β in spleens from tumor bearing mice. 4T1 tumors express procoagulant tissue factor (TF) and spontaneously release TF(+) microparticles which are potent procoagulant factors that promote thrombin generation. Treatment with dabigatran etexilate alone prevented tumor-induced increases in circulating TF(+) microparticles and also decreased the numbers of tumor-induced activated platelets by 40%. These results show that co-treatment with dabigatran etexilate and CP synergistically inhibits growth and metastasis of mammary tumors, suggesting that oral administration of the thrombin inhibitor dabigatran etexilate may be beneficial in not only preventing thrombotic events in cancer patients but also in treating malignant tumors themselves.
Collapse
Affiliation(s)
| | | | - Candace S Hayes
- a Lankenau Institute for Medical Research ; Wynnewood , PA USA
| | - Ashley Goss
- b Boehringer Ingelheim Pharmaceuticals Inc. ; Ridgefield , CT USA
| | - Joanne Van Ryn
- c Boehringer Ingelheim Pharma GmbH & Co. KG ; Biberach an der Riss , Germany
| | - Susan K Gilmour
- a Lankenau Institute for Medical Research ; Wynnewood , PA USA
| |
Collapse
|
190
|
Dugbartey GJ, Peppone LJ, de Graaf IAM. An integrative view of cisplatin-induced renal and cardiac toxicities: Molecular mechanisms, current treatment challenges and potential protective measures. Toxicology 2016; 371:58-66. [PMID: 27717837 DOI: 10.1016/j.tox.2016.10.001] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/03/2016] [Accepted: 10/03/2016] [Indexed: 02/06/2023]
Abstract
Cisplatin is currently one of the most widely-used chemotherapeutic agents against various malignancies. Its clinical application is limited, however, by inherent renal and cardiac toxicities and other side effects, of which the underlying mechanisms are only partly understood. Experimental studies show cisplatin generates reactive oxygen species, which impair the cell's antioxidant defense system, causing oxidative stress and potentiating injury, thereby culminating in kidney and heart failure. Understanding the molecular mechanisms of cisplatin-induced renal and cardiac toxicities may allow clinicians to prevent or treat this problem better and may also provide a model for investigating drug-induced organ toxicity in general. This review discusses some of the major molecular mechanisms of cisplatin-induced renal and cardiac toxicities including disruption of ionic homeostasis and energy status of the cell leading to cell injury and cell death. We highlight clinical manifestations of both toxicities as well as (novel)biomarkers such as kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase-1 (TIMP-1) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We also present some current treatment challenges and propose potential protective strategies including combination therapy with novel pharmacological compounds that might mitigate or prevent these toxicities, which include the use of hydrogen sulfide.
Collapse
Affiliation(s)
- George J Dugbartey
- Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Luke J Peppone
- Department of Surgery, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY, United States
| | - Inge A M de Graaf
- Division of Pharmacokinetics, Toxicology and Targeting, Department of Pharmacy, University of Groningen, Groningen, Netherlands
| |
Collapse
|
191
|
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM, Zamorano JL, Aboyans V, Achenbach S, Agewall S, Badimon L, Barón‐Esquivias G, Baumgartner H, Bax JJ, Bueno H, Carerj S, Dean V, Erol Ç, Fitzsimons D, Gaemperli O, Kirchhof P, Kolh P, Lancellotti P, Lip GYH, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Roffi M, Torbicki A, Vaz Carneiro A, Windecker S, Achenbach S, Minotti G, Agewall S, Badimon L, Bueno H, Cardinale D, Carerj S, Curigliano G, de Azambuja E, Dent S, Erol C, Ewer MS, Farmakis D, Fietkau R, Fitzsimons D, Gaemperli O, Kirchhof P, Kohl P, McGale P, Ponikowski P, Ringwald J, Roffi M, Schulz‐Menger J, Stebbing J, Steiner RK, Szmit S, Vaz Carneiro A, Windecker S. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur J Heart Fail 2016; 19:9-42. [DOI: 10.1002/ejhf.654] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
192
|
Zamorano JL, Lancellotti P, Rodriguez Muñoz D, Aboyans V, Asteggiano R, Galderisi M, Habib G, Lenihan DJ, Lip GYH, Lyon AR, Lopez Fernandez T, Mohty D, Piepoli MF, Tamargo J, Torbicki A, Suter TM. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016; 37:2768-2801. [DOI: 10.1093/eurheartj/ehw211] [Citation(s) in RCA: 1498] [Impact Index Per Article: 187.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
193
|
Reck M, Thomas M, Kropf-Sanchen C, Mezger J, Socinski MA, Depenbrock H, Soldatenkova V, Brown J, Krause T, Thatcher N. Necitumumab plus Gemcitabine and Cisplatin as First-Line Therapy in Patients with Stage IV EGFR- Expressing Squamous Non-Small-Cell Lung Cancer: German Subgroup Data from an Open-Label, Randomized Controlled Phase 3 Study (SQUIRE). Oncol Res Treat 2016; 39:539-47. [PMID: 27614872 DOI: 10.1159/000448085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the SQUIRE study, adding the anti-epidermal growth factor receptor (EGFR) IgG1 antibody necitumumab to first-line gemcitabine and cisplatin (GC + N) in advanced squamous non-small-cell lung cancer (sqNSCLC) significantly improved overall survival (OS); the safety profile was acceptable. We explored data for the German subpopulation (N = 96) of SQUIRE patients with EGFR-expressing tumors. PATIENT AND METHODS Patients with stage IV sqNSCLC were randomized 1:1 to up to 6 cycles of open-label GC + N or GC alone. GC + N patients with no progression continued on necitumumab monotherapy until disease progression or intolerable toxicity. The primary endpoint was OS; the secondary endpoints included progression-free survival (PFS), safety and health-related quality of life (EQ-5D, Lung Cancer Symptom Scale (LCSS)). RESULTS The 96 German SQUIRE patients with EGFR-expressing tumors (GC + N 42, GC 54) received a median of 4 GC cycles; the GC + N patients received 5 cycles of necitumumab. Adding necitumumab was associated with 41% risk reduction of death (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.37-0.94, p = 0.026) and 44% risk reduction of progression (HR 0.56, 95% CI 0.33-0.95, p = 0.029). Adverse events typically associated with EGFR antibody treatment (including rash, hypomagnesemia) were more common with GC + N. The time to deterioration of the EQ-5D and LCSS scores showed no notable differences between the treatment arms, except for appetite loss (delayed for GC + N). CONCLUSION The survival benefit from adding necitumumab to first-line GC was more pronounced in the German SQUIRE subpopulation with EGFR-expressing tumors than in the overall (intention-to-treat) population; toxicity was manageable and consistent with the overall population.
Collapse
Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), German Center for Lung Research (DZL), German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
194
|
Kang JR, Long LH, Yan SW, Wei WW, Jun HZ, Chen W. Peripherally Inserted Central Catheter-Related Vein Thrombosis in Patients With Lung Cancer. Clin Appl Thromb Hemost 2016. [PMID: 26207019 DOI: 10.1177/1076029615595880] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Peripherally inserted central venous catheters (PICCs) are widely used in patients with cancer. Catheter usage is one of the risk factors for venous thromboembolism. We aimed to scrutinize the incidence and risk factors for PICC-related upper extremity venous thrombosis (UEVT) in patients with lung cancer receiving chemotherapy. Patients and Methods: We performed a retrospective cohort study of patients with lung cancer with PICC insertion undergoing chemotherapy. Symptomatic PICC-UEVT was diagnosed by ultrasound. The relationship between chemotherapeutic agent exposure and PICC-UEVT was evaluated. Patient-, catheter-, and insertion-related factors were analyzed in univariable and multivariable logistic regression to identify significant independent risk factors for PICC-UEVT in patients with lung cancer. Results: A total of 328 patients with lung cancer having PICC undergoing chemotherapy were included, for a total of 34 895 catheter days. Seventeen (5.2%) patients developed PICC-related UEVT, with an incidence of 0.49 per 1000 catheter days. In multivariable logistic analysis, advanced disease was shown to be a significant risk factor for PICC-UEVT (odds ratio [OR]: 4.9; 95% confidence interval [CI]: 1.4-16.7; P = .011). Patients treated with etoposide had a higher risk of PICC-related UEVT (OR: 3.6; 95% CI: 1.1-12.1; P = .042). Patients were followed up after PICC removal for a median duration of 246 days. None of the patients developed pulmonary embolism. Conclusion: Patients with lung cancer harboring an advanced disease or treating with etoposide were at higher risk of PICC-UEVT.
Collapse
Affiliation(s)
- Jun Ren Kang
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Hai Long
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sun Wen Yan
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang Wei Wei
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Zhi Jun
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy Of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Parenteral and Enteral Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
195
|
Matsuo K, Moeini A, Machida H, Fullerton ME, Shabalova A, Brunette LL, Roman LD. Significance of venous thromboembolism in women with cervical cancer. Gynecol Oncol 2016; 142:405-12. [PMID: 27350404 DOI: 10.1016/j.ygyno.2016.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/11/2016] [Accepted: 06/14/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize risk factors of venous thromboembolism (VTE) and to examine effects of VTE on survival of women with cervical cancer. METHODS This is a retrospective study examining consecutive stage I-IV cervical cancer cases diagnosed between 2000 and 2014. Cumulative risk of VTE after cervical cancer diagnosis was evaluated by a time-dependent analysis, expressing adjusted-hazard ratio [HR] and 95% confidence interval [CI]. Survival analysis was performed to determine independent risk factors for progression-free survival (PFS) and disease-specific overall survival (OS). RESULTS VTE was recorded in 98 (12.3%, 95%CI 11.6-22.8) out of 798 cases with 1-, 2-, and 5-year cumulative incidences after cervical cancer diagnosis being 8.4%, 11.3%, and 18.7%, respectively. On multivariable analysis, advanced-stage disease (2-year cumulative risk, distant metastatic disease 44.8% [HR 4.13, 95%CI 1.06-10.7, P=0.003], and locally-advanced disease 13.4% [HR 2.46, 95%CI 1.17-4.43, P=0.004]) were independently associated with increased risk of VTE compared to early-stage disease (stage IA1-IB1 4.1%). In addition, low albumin level (HR per unit change, 0.59, 95%CI 0.40-0.85, P=0.005) and chemotherapy treatment (HR 2.46, 95%CI 1.30-4.66, P=0.006) remained independent risk factors associated with increased risk of VTE. On univariate analysis, VTE was significantly associated with decreased PFS (5-year rates, 22.3% versus 68.7%, P<0.001) and OS (5-year rates, 55.1% versus 90.0%, P<0.001). On multivariable analysis, VTE remained an independent prognostic factor associated with decreased PFS (HR 1.95, 95%CI 1.43-2.67, P<0.001) and OS (HR 3.54, 95%CI 2.04-6.13, P<0.001). CONCLUSION VTE represents aggressive tumor behavior and poor patient condition, and is an independent prognostic factor for decreased survival in women with cervical cancer.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Aida Moeini
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Morgan E Fullerton
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Anastasiya Shabalova
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laurie L Brunette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
196
|
Omersa D, Cufer T, Marcun R, Lainscak M. Echocardiography and cardiac biomarkers in patients with non-small cell lung cancer treated with platinum-based chemotherapy. Radiol Oncol 2016; 51:15-22. [PMID: 28265228 PMCID: PMC5330165 DOI: 10.1515/raon-2016-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/08/2016] [Indexed: 01/05/2023] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and remains an important cause of cancer death worldwide. Platinum-based chemotherapy (PBC) for NSCLC can modify outcome while the risk of cardiotoxicity remains poorly researched. We aimed to evaluate the incidence and severity of cardiac injury during PBC in patients with NSCLC and to identify patients at risk. Methods This was a single-centre, prospective, observational study of patients with early and advanced stage NSCLC referred for PBC. In addition to standard care, patients were examined and evaluated for cardiotoxicity before the first dose (visit 1), at the last dose (visit 2) and 6 months after the last dose of PBC (visit 3). Cardiotoxicity (at visit 2 and 3) was defined as increase in the ultrasensitive troponin T, N-terminal pro-B type natriuretic peptide or decrease in left ventricular ejection fraction (LVEF). Results Overall, 41 patients (mean age 61 ± 9; 54% men; 68% advanced lung cancer) were included. The median number of PBC cycles was 4. During the study period, there were no incidents of heart failure, and 3 deaths caused by tumour progression were recorded. The mean values of biomarkers and LVEF did not change significantly (p > 0.20). However, 10 (25%) had cardiotoxicity which was independently associated with a history of ischemic heart disease (p = 0.026). Conclusions In NSCLC, cardiac assessment and lifestyle modifications may be pursued in patients with a history of cardiac disease and in patients with longer life expectancy.
Collapse
Affiliation(s)
- Daniel Omersa
- National Institute of Public Health, Ljubljana, Slovenia
| | - Tanja Cufer
- University Clinic Golnik, Golnik, Slovenia; Faculty of Medicine, Ljubljana, Slovenia
| | | | - Mitja Lainscak
- Faculty of Medicine, Ljubljana, Slovenia; Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
| |
Collapse
|
197
|
Bonnerot M, Humbertjean L, Mione G, Lacour JC, Derelle AL, Sanchez JC, Riou-Comte N, Richard S. Cerebral ischemic events in patients with pancreatic cancer: A retrospective cohort study of 17 patients and a literature review. Medicine (Baltimore) 2016; 95:e4009. [PMID: 27368015 PMCID: PMC4937929 DOI: 10.1097/md.0000000000004009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Stroke is a dramatic complication of pancreatic cancer with mechanisms related to oncological disease. A better description of the characteristics of cerebrovascular events would help better understand the pathogeny and protect vulnerable patients. We thus conducted a descriptive analysis of clinical, biological, and radiological features of patients from our centers and literature.We reviewed consecutive cases of patients who presented cerebrovascular events and pancreatic cancer in 4 stroke units in Lorrain (France) between January 1, 2009 and March 31, 2015, and all reported cases of literature. We identified 17 cases in our centers and 18 reported cases. Fifty-seven per cent of patients were male. Median age was 63 ± 14 years and ranged from 23 to 81 years. All cerebral events were ischemic. At the onset of stroke, pancreatic cancer had already been diagnosed in 59% of the patients in our centers for a mean time of 5.4 months. Five of them (29%) were being treated with gemcitabine and 2 (12%) with folfirinox. Adenocarcinoma at metastatic stage was reported in 82% of cases overall. Brain imaging revealed disseminated infarctions in 64%. High median levels of D-dimer (7600 ± 5 × 10 μg/L), C-reactive protein (63 ± 43 mg/L), and elevated prothrombin time (19 ± 6 seconds) were found. Thirty-six per cent of patients explored with echocardiography were diagnosed with nonbacterial thrombotic endocarditis. Ten of our patients received anticoagulant therapy as secondary stroke prevention without any documented recurrence. Nevertheless, outcome was poor with a median survival time of 28 ± 14 days after stroke onset. Cerebral ischemic events occur at advanced stages of pancreatic cancer, most likely by a thromboembolic mechanism. Disseminated infarctions and high D-dimer, C-reactive protein levels, and a high prothrombin time are the most constant characteristics found in this context. All patients should be screened for nonbacterial thrombotic endocarditis as this etiology supports the use of anticoagulant therapy.
Collapse
Affiliation(s)
| | | | | | | | - Anne-Laure Derelle
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Jean-Charles Sanchez
- Department of Human Protein Sciences, University Medical Center, Geneva, Switzerland
| | | | - Sébastien Richard
- Department of Neurology, Stroke Unit
- Department of Human Protein Sciences, University Medical Center, Geneva, Switzerland
- Centre d’Investigation Clinique Plurithématique Pierre Drouin, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- Correspondence: Sébastien Richard, Service de Neurologie – Unité Neurovasculaire, Hôpital Central, 29 avenue Maréchal de Lattre de Tassigny, CO n°34, 54035 Nancy, Cedex, France (e-mail: )
| |
Collapse
|
198
|
|
199
|
Solari L, Krönig M, Ihorst G, Drognitz K, Heinz J, Jilg CA, Schultze-Seemann W, Engelhardt M, Waller CF. High Rates of Thromboembolic Events in Patients with Germ Cell Cancer Undergoing Cisplatin-Based Polychemotherapy. Urol Int 2016; 96:399-405. [PMID: 27074038 DOI: 10.1159/000445126] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/29/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND We examined whether or not extended prophylaxis with low molecular weight heparin (LMWH) would significantly reduce thromboembolic event (TEE) rates in germ cell cancer patients undergoing cisplatin-based chemotherapy. PATIENTS AND METHODS LMWH prophylaxis was given from the first day of chemotherapy until 21 days after completing the last chemotherapy cycle to 45 out of 93 (48.4%) patients (extended), and to 48 out of 93 (51.6%) patients during their hospitalization only (limited) between January 2008 and December 2013. Patients were analyzed retrospectively for TEEs such as deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI) or peripheral arterial thrombosis. RESULTS A total of 22/93 (23.7%) patients experienced 30 TEE during chemotherapy: 12 out of 30 (40%) deep vein thrombosis, 4 out of 30 (13.3%) MI, 10 out of 30 (33.3%) PE and 4 out of 30 peripheral arterial thrombosis (13.3%). TEE rates in both groups did not differ significantly (extended: 26.7 vs. limited: 20.8%). CONCLUSIONS The introduction of extended LMWH prophylaxis did not significantly reduce TEE rates in our patient cohort.
Collapse
Affiliation(s)
- L Solari
- Department of Hematology, Oncology and Stem Cell Transplantation, University of Freiburg Medical Centre, Freiburg, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
200
|
Incidental venous thromboembolic events in cancer patients: what we know in 2016. Thromb Res 2016; 140 Suppl 1:S18-20. [DOI: 10.1016/s0049-3848(16)30093-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|