Early detection of venous thromboembolism after the initiation of chemotherapy predicts a poor prognosis in patients with unresectable metastatic pancreatic cancer who underwent first-line chemotherapy with gemcitabine plus nab-paclitaxel

Abstract

Background Pancreatic cancer is associated with a high thromboembolism risk. We investigated the significance of early venous thromboembolism (VTE) detection in patients with unresectable metastatic pancreatic cancer (UR-MPC) who received first-line chemotherapy with gemcitabine plus nab-paclitaxel (GnP). Methods This single-center retrospective study enrolled 174 patients with UR-MPC who underwent GnP as a first-line chemotherapy from April 2017 to March 2020. The early detection of VTE (deep venous thrombosis and pulmonary thromboembolism) was defined as diagnosis by the first follow-up CT scan after the initiation of chemotherapy. We compared the patients with early detection of VTE (VTE (+) group) with the others (VTE (-) group). We examined overall survival (OS), progress free survival (PFS), severe adverse events, and predictors associated with OS using the Cox proportional hazards model. Results Early detection of VTE was observed in 17 patients (9.8%). Thirteen patients were diagnosed with VTE at treatment initiation, and four patients were diagnosed after treatment initiation. The median time to diagnosis after treatment initiation was 55 days (range: 31–71 days). Only 3 patients were symptomatic. The VTE (+) group exhibited worse OS and PFS than the VTE (-) group (OS: 259 days vs. 400 days, P < 0.001; PFS: 120 days vs. 162 days, P = 0.008). The frequency of grade 3–4 adverse events was not significantly different. Although the performance status was poorer in the VTE (+) group, VTE was identified as a statistically significant independent predictor for OS in multivariate analyses (HR, 1.87; 95% CI, 1.02–3.44; P = 0.041). Conclusions Early VTE detection is a predictor of a poor prognosis in UR-MPC patients who receive GnP as first-line chemotherapy, suggesting that screening VTE for patients with UR-MPC is crucial, even if patients are asymptomatic.

Prognostic value of venous thromboembolism in patients with advanced pancreatic cancer: a systematic review and meta-analysis

“…The sample sizes in these studies ranged from 170 to 838. Among the ten studies, 1,903 Asian patients ( 17 , 18 , 20 , 22 , 23 ) and 1,242 European and American patients ( 14 – 16 , 19 , 21 ) were enrolled. The majority of the patients were middle-aged and elderly individuals diagnosed with advanced pancreatic cancer.…”

“…The majority of the patients were middle-aged and elderly individuals diagnosed with advanced pancreatic cancer. Treatment modalities included chemotherapy ( 14 – 16 , 18 – 20 , 22 , 23 ) or chemoradiotherapy ( 17 , 21 ). Our research aimed to assess the predictive value of VTE in patients with advanced pancreatic cancer by combining OS and DFS data.…”

Venous Thromboembolism in Patients with Advanced Pancreatic Cancer Receiving Palliative Chemotherapy: Incidence and Effect on Prognosis

“…26 particularly in early VTE, which was defined as within 1.5 months after the initiation of chemotherapy or within 3 months after diagnosis of PDAC. 7,9,13,16 Other studies reported that the occurrence of VTE does not significantly affect the prognosis. 5,8,11,14 As mentioned above, this is probably explained by the difference in the study population among studies.…”

“…7,9,10, 12,16 . On the contrary, several studies reported that the occurrence of VTE was not associated with OS.…”

Cellular Components Contributing to the Development of Venous Thrombosis in Patients with Pancreatic Cancer

“…[104][105][106] In patients with PDAC, iron deficiency rates of 60% and anemia rates of 30% at diagnosis have been reported. [105][106][107][108] Chemotherapy can cause or worsen anemia. PDAC patients are regularly treated with chemotherapy regimens containing one or more of the following chemotherapeutic agents; 5-fluorouracil, gemcitabine, irinotecan, nab-paclitaxel, and oxaliplatin, for which anemia incidences around 80 to 90% have been found.…”