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Clinical impact of venous thromboembolism in non-small cell lung cancer patients receiving immunotherapy

  • Birgitte Bjørnhart
    Correspondence
    Corresponding author at: Department of Oncology, Odense University Hospital, Kloevervaenget 8, 109, 5000 Odense, Denmark.
    Affiliations
    Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark

    Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark

    OPEN, Odense Patient Data Explorative Network, Odense University Hospital, J.B.Winsløws Vej 9a, 5000 Odense, Denmark

    Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
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  • Charlotte Kristiansen
    Affiliations
    Department of Oncology, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark
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  • Jon Asmussen
    Affiliations
    Department of Radiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
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  • Karin Holmskov Hansen
    Affiliations
    Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark

    OPEN, Odense Patient Data Explorative Network, Odense University Hospital, J.B.Winsløws Vej 9a, 5000 Odense, Denmark
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  • Kim Wedervang
    Affiliations
    Department of Oncology, Hospital Soenderjylland, Sydvang 1, 6400 Soenderborg, Denmark
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  • Trine Lembrecht Jørgensen
    Affiliations
    Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark

    Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark

    Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
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  • Jørn Herrstedt
    Affiliations
    Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark

    Department of Clinical Oncology and Palliative Care, Zealand University Hospital Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark
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  • Tine Schytte
    Affiliations
    Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark

    Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19,3, 5000 Odense, Denmark

    Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark
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Published:November 05, 2022DOI:https://doi.org/10.1016/j.thromres.2022.10.020

      Abstract

      Background

      Prospective investigation on cancer-associated venous thromboembolism (VTE) in non-small cell lung cancer (NSCLC) during treatment with immune checkpoint inhibitors (ICIs) is lacking.

      Patients and methods

      A prospective real-world study using combined computed tomography venography and pulmonary angiography (CTVPA) to screen patients with NSCLC for VTE (cohort A). A retrospective multicenter cohort without additional screening with CTVPA was included as control (cohort B). A model with VTE as a time-dependent event using competing risk analysis model with death as a competing event was used to evaluate outcomes and differences in cumulative VTE incidences.

      Results

      Cohort A (n = 146) and cohort B (n = 426) had median follow-up for VTE of 16.5 months (IQR 6.7–35.6). Cumulative VTE events at 1, 3, 6, and 12 months were 7.5 %, 9.6 %, 13.0 %, 14.4 % for cohort A and 1.9 %, 3.8 %, 4.9 %, 5.6 % for cohort B with SHR 2.42 (CI 95 % 1.37–4.27) p = 0.0024. Recurrent VTE comprised 52 % and 37 %, respectively. In multivariate overall survival analysis, VTE was significantly associated with impaired OS (HR 2.12 CI 95 % [1.49–3.03], p < 0.0001). Risk factors for VTE comprised prior VTE and ICI administered in first line.

      Conclusion

      Cumulative VTE incidence in NSCLC patients following palliative ICI may be significantly higher than reported in randomised clinical trials and retrospective real-world reports. VTE development during ICI impair OS significantly. Thus, more focus on VTE during ICI is warranted to optimise both prevention and management of VTE. Whether there is a causal relationship between VTE and ICI remains to be explored.

      Keywords

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