Incidence and risk of thromboembolism associated with bevacizumab in patients with non-small cell lung carcinoma

Li, Lijuan; Chen, Difei; Wu, Guofeng; Guan, Weijun; Zhu, Zheng; Gao, Guoying; Qin, Yinyin; Zhong, Nanshan

doi:10.21037/jtd.2018.07.09

Cited by 9 publications

(7 citation statements)

References 38 publications

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“…Gemcitabine and platinum-containing chemotherapy were the most commonly reported treatment-related prognostic factors for VTE. Similar to previous studies, [35][36][37] we found that the use of platinum-based compounds was associated with an increased risk of VTE across the included studies. The association between the use of gemcitabine and VTE was less conclusive, despite previous studies suggesting that this treatment increased the risk of VTE, 37,38 which may be explained by adjustment factors and potential confounding.…”

Section: Vegfa-1190g/asupporting

confidence: 88%

Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review

Lee

Shenoy

Shi

et al. 2021

TH Open

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Background Patients undergoing systemic cancer therapy are susceptible to developing venous thromboembolism (VTE). The most pertinent prognostic factors for VTE remain unclear. This systematic review aims to summarize prognostic factors associated with VTE in this population. Methods MEDLINE, Embase, and CENTRAL databases were searched for observational or randomized studies that used multivariable analysis adjusted for tumor type and/or metastatic disease to model the risk of VTE. Adjusted effect estimates for each prognostic factor were collected for all of the included studies. Risk of bias was assessed using the Quality in Prognostic Factor Studies (QUIPS) tool. Results From 5,988 search results, 15 eligible studies and 42 prognostic factors were identified. A total of 8,554 patients of whom 456 (5.33%) developed VTE were included. Fourteen studies had a high risk of bias and one study had a moderate risk. The most commonly reported prognostic factors include age, gender, tumor site, metastasis, performance status, and systemic therapy type. Poor performance status and the use of platinum-based chemotherapy compounds were associated with an increased risk of VTE across the majority of studies. The evidence to suggest that the other prognostic factors identified were associated with VTE development was inconclusive. Several individual studies identified novel biomarkers for VTE. Heterogeneity in statistical methods and prognostic factor definitions across studies precluded meta-analysis. Conclusion Overall, many prognostic factors were identified; however, the evidence for association with development of VTE for most of the factors is inconclusive. Findings were limited by high heterogeneity and risk of bias in the included studies.

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Section: Vegfa-1190g/asupporting

confidence: 88%

Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review

Lee

Shenoy

Shi

et al. 2021

TH Open

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“…The incidence of treatment-related TE was 3.5% in our patients, which was lower compared with prior studies. 16,17,24 It may be that these studies did not classify TE as disease-or treatment-related. Moreover, proteinuria was an independent predictor of treatment-related TE.…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcome of advanced NSCLC patients receiving antiangiogenic therapy with thromboembolic events: a retrospective cohort study

Liao

Hsu

et al. 2022

Preprint

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Background Antiangiogenic therapy is widely used in advanced non-small cell lung cancer (NSCLC) patients. The purpose of this study was to investigate the incidence, risk factors, and outcome of advanced NSCLC patients receiving antiangiogenic therapy with thromboembolic events (TE). Methods This was a retrospective study, which included advanced NSCLC patients receiving antiangiogenic therapy from March 2013 to May 2021 at Taichung Veterans General Hospital. All TE were confirmed by objective image studies. We further categorized TE into disease-related and treatment-related according to the tumor control status when TE occurred. Results A total of 427 patients were included. The overall incidence of TE was 10.1% (n = 43); among these patients, 28 (6.6%) and 15 (3.5%) patients were categorized into disease- and treatment-related TE, respectively. Multivariate analysis suggested that the use of hormone and proteinuria independently predicted a higher TE incidence among patients with disease-related TE (adjusted odds ratio [aOR] 2.79 [95% CI 1.13 = 6.92]; P = 0.027) and treatment-related TE (aOR 4.30 [95% CI 1.13–16.42]; P = 0.033), respectively. As compared with patients without TE, disease-related TE significantly predicted a shorter median overall survival (21.6 vs. 31.4 months, adjusted hazard ratio [aHR] 1.30 [95% CI 1.05–1.61]; P = 0.017), but patients with treatment-related TE had comparable survival time (32.7 vs. 31.4 months; aHR 1.05 [95% CI 0.57–1.61]; P = 0.876). Conclusion Patients receiving antiangiogenic therapy with TE should be further differentiated whether it is treatment- or disease-related, because the two groups had different risk factors and influences on outcome.

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“…The largest meta-analysis, which included 20,500 patients with multiple cancer types found an increased risk for ATE and VTE, but no subgroup analysis for cancer type was made [ 52 ]. In advanced lung cancer, a Chinese meta-analysis found an increased risk for all TEs (RR 1.74; 95% CI, 1.15–2.62) but did not make a subanalysis for VTE or ATE [ 53 ]. The increased risk was driven by the high-dose group (15 mg/m 2 Q3w), whereas the result in the low-dose group (7.5 mg/m 2 ) was not significant [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…In advanced lung cancer, a Chinese meta-analysis found an increased risk for all TEs (RR 1.74; 95% CI, 1.15–2.62) but did not make a subanalysis for VTE or ATE [ 53 ]. The increased risk was driven by the high-dose group (15 mg/m 2 Q3w), whereas the result in the low-dose group (7.5 mg/m 2 ) was not significant [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of Thrombo-Embolic Events in Ovarian Cancer: Does Bevacizumab Tilt the Scale? A Systematic Review and Meta-Analysis

Saerens

Jaeghere

Kanervo

et al. 2021

Cancers

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Thromboembolic events are the second cause of death in cancer patients. In ovarian cancer, 3–10% of patients present with venous thromboembolism (VTE), but the incidence may rise to 36% along the disease course. Bevacizumab is a monoclonal antibody directed against vascular endothelial-derived growth factor, and in in vitro studies it showed a predisposition to hemostasis perturbation, including thrombosis. However, in vivo and clinical studies have shown conflicting results for its use as a treatment for ovarian cancer, so we conducted a systematic review and meta-analysis on the risk of arterial thromboembolism (ATE) and VTE in ovarian cancer patients treated with bevacizumab. The review comprised 14 trials with 6221 patients: ATE incidence was reported in 5 (4811 patients) where the absolute risk was 2.4% with bevacizumab vs. 1.1% without (RR 2.45; 95% CI 1.27–4.27, p = 0.008). VTE incidence was reported in 9 trials (5121 patients) where the absolute risk was 5.4% with bevacizumab vs. 3.7% without (RR 1.32; 95% CI 1.02–1.79, p = 0.04). Our analysis showed that the risk of arterial and venous thromboembolism increased in patients treated with bevacizumab. Thrombolic events (TEs) are probably underreported, and studies should discriminate between ATE and VTE. Bevacizumab can be considered as an additional risk factor when selecting patients for primary prophylaxis with anticoagulants.

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Incidence and risk of thromboembolism associated with bevacizumab in patients with non-small cell lung carcinoma

Abstract: Bevacizumab is associated with a significantly increased risk of thromboembolism development in NSCLC patients. It may have dose-toxicity relationship and low dose of bevacizumab may be a better choice for NSCLC patients, with equal efficacy and low hazard of thromboembolism events.

Cited by 9 publications

References 38 publications

Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review

Prognostic Factors for Venous Thromboembolism in Patients with Solid Tumours on Systemic Therapy: A Systematic Review

Incidence, risk factors, and outcome of advanced NSCLC patients receiving antiangiogenic therapy with thromboembolic events: a retrospective cohort study

Risk of Thrombo-Embolic Events in Ovarian Cancer: Does Bevacizumab Tilt the Scale? A Systematic Review and Meta-Analysis

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