A snapshot of cancer-associated thromboembolic disease in 2018–2019: First data from the TESEO prospective registry

Abstract

Background: The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. Method: TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. Results: Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. Conclusion: CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.

Bleeding with Apixaban and Dalteparin in Patients with Cancer-Associated Venous Thromboembolism: Results from the Caravaggio Study

“…The distribution of the sites of cancer was also similar to that seen in the population of patients with cancerassociated VTE as shown by the most recent prospective study on cancer and VTE. 22 Strengths of this analysis include the large sample of patients enrolled in the study and the characteristics of the study population with the inclusion of a large proportion of patients with advanced cancer who represent the most challenging patients.…”

Apixaban and Dalteparin for the Treatment of Venous Thromboembolism in Patients with Different Sites of Cancer

“…Most of the thromboembolic events were seen to be early, although slightly dissimilar patterns are apparent in different sites of primary cancer, as already seen in the most recent prospective study. 20 This observation indicates the need to evaluate longitudinally the thrombotic risk and the occurrence of VTE, taking into account the differences in the course of the disease that can have a homogenous evolution, as pancreatic cancer, or alternate remissions and relapses, as ovarian or breast cancer.…”

Identification of Thrombosis-Related Genes in Patients with Advanced Gastric Cancer: Data from AGAMENON-SEOM Registry

“…The p-value of each regression is presented, as well as 2 the odd ratios that express the relation between the expression of each gene and thrombotic risk in the full cohort. Similarly, 3 the confidence interval (95%) of each odd ratio is shown. 4 The odd ratios above 1 on this axis indicated that the greater the gene expression, the greater associated thrombotic risk in the overall cohort, whereas values of less than 1 indicated that the greater the expression, the lower the associated risk.…”