Thromboembolism in Patients with Metastatic Urothelial Cancer Treated with Immune Checkpoint Inhibitors.

Autor: Sheng IY; Department of Medicine, Beth Israel Lahey Mt. Auburn Hospital, Boston, MA, USA., Gupta S; Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA., Reddy CA; Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA., Angelini D; Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA., Funchain P; Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA., Sussman TA; Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA., Sleiman J; Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Ornstein MC; Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA., McCrae K; Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA., Khorana AA; Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, 10201 Carnegie Ave/CA 60, Cleveland, OH, 44106, USA. khorana@ccf.org.
Jazyk: angličtina
Zdroj: Targeted oncology [Target Oncol] 2022 Sep; Vol. 17 (5), pp. 563-569. Date of Electronic Publication: 2022 Aug 20.
DOI: 10.1007/s11523-022-00905-x
Abstrakt: Background: Immunotherapy has become one of the mainstays for metastatic urothelial carcinoma treatment. Whether immune checkpoint inhibitor therapy increases thromboembolism (TE) risk is unknown.
Objective: We investigated the incidence of arterial thromboembolism (ATE) and venous thromboembolism (VTE) events and its associated outcomes in patients with metastatic urothelial cancer treated with immune checkpoint inhibitors.
Methods: Patients with urothelial cancer treated with immune checkpoint inhibitors at the Cleveland Clinic from 1/1/2015 to 12/31/2019 were identified. The Kaplan-Meier method estimated overall survival and Cox proportional hazards regression evaluated the impact of TE on overall survival.
Results: Of 279 patients, 72% were men with pure urothelial cancer (62%) who started atezolizumab (40%), nivolumab (3%), or pembrolizumab (57%). At a median follow-up of 5.6 months (range 0.3-51.6), 42 patients developed a TE (VTE n = 37, 13%, ATE n = 5, 2%). The cumulative incidence of TE after immune checkpoint inhibitor therapy was 9.1% (95% confidence interval 6.0-13.0) at 6 months and 13.6% (95% confidence interval 9.6-18.4) at 12 months. Most TE (VTE 62%, ATE 100%) occurred within 6 months of immune checkpoint inhibitor initiation (median doses 5, range 1-59), and the majority (VTE 81%, ATE 100%) resulted in hospitalization (median: 5 days, 4 days, respectively). Thromboembolism (hazard ratio 2.296, p = 0.0004), Bajorin score 1 or 2 (hazard ratio 1.490, p = 0.0315), and Bajorin score 2 (hazard ratio 3.50, p < 0.0001) were associated with worse overall survival.
Conclusions: Immune checkpoint inhibitors are associated with a high TE risk. Thromboembolism is associated with worsened survival, among other poor outcomes. Further investigation into the mechanism behind immune checkpoint inhibitor-associated TE is needed.
(© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
Databáze: MEDLINE
Externí odkaz: