Incidence and Timing of Thromboembolic Events in Patients With Ovarian Cancer Undergoing Neoadjuvant Chemotherapy

Greco, Patricia; Bazzi, Ali; McLean, Karen; Reynolds, R. Kevin; Spencer, Ryan; Johnston, Carolyn; Liu, J. Rebecca; Uppal, Shitanshu

doi:10.1097/ogx.0000000000000480

Cited by 3 publications

(8 citation statements)

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“…Recently published smaller cohort studies propose that chemotherapy might have a higher influence on the risk of VTE than surgery. 11,12,23 The present study found similar HRs of VTE in EOC bleeding risk. 40,41 Gynecologic cancer patients are considered at high risk of developing VTE during chemotherapy according to the Khorana score and need only one other risk factor to fulfill the criteria to receive VTE prophylaxis during ambulant anticancer treatment according to the updated guidelines.…”

Section: Eoc Patients (%) Asupporting

confidence: 82%

“…9,10 Recent studies found that at least 10% of EOC patients developed VTE events during chemotherapy. 11,12 Treatment of EOC is complex and patients are often exposed to surgery and chemotherapy more than once, because relapse or progression is common. 13 The association between VTE and previously identified risk factors in EOC patients is complex, and has, to our knowledge, not previously been addressed with a multivariable time-dependent approach in a larger scale.…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic cancer surgery is associated with a high risk of VTE and 4 weeks of extended pharmacologic prophylaxis is recommended, and is estimated to be cost‐effective, in ovarian cancer 9,10 . Recent studies found that at least 10% of EOC patients developed VTE events during chemotherapy 11,12 . Treatment of EOC is complex and patients are often exposed to surgery and chemotherapy more than once, because relapse or progression is common 13 .…”

Section: Introductionmentioning

confidence: 99%

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The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study

Kahr

Christiansen

Riddersholm

et al. 2021

Journal of Thrombosis and Haemostasis

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Background and aim: Venous thromboembolism (VTE) is associated with excess mortality and morbidity in cancer, and is influenced by patient-, tumor-, and treatmentrelated factors. We aimed to investigate the impact of such factors in a national cohort of patients with epithelial ovarian cancer (EOC). Methods: Patients in the Danish Gynecologic Cancer Database (DGCD) with EOC from 2005 to 2014 were followed from time of diagnosis to VTE, or censoring. Surgery, chemotherapy, and vascular epithelial growth factor (VEGF)-inhibitors were included as time-varying exposures in Cox proportional hazard regression models. Results: A total of 551 VTE events were registered in 4991 EOC patients. Median follow-up time was 2.9 years. The 2-year cumulative incidence of VTE was 7.2%. Patients were at highest risk during the first year after EOC diagnosis. Previous VTE was associated with a hazard ratio (HR) of 3.26 (95% confidence interval [CI] 2.42-4.39). Exposure to major pelvic surgery was associated with a HR of 3.21 (95% CI 2.29-4.50). Exposure to chemotherapy or (VEGF)-inhibitors were associated with HRs of 1.91 (95% CI 1.56-2.33) and 1.05 (95% CI 0.57-1.93), respectively. Hazard ratios for patients with clear cell histopathology was 1.46 (95% CI 0.97-2.20) and 2.42 for International Federation of Gynaecology and Obstetrics stage III-IV (95% CI 1.93-3.03). Conclusions: EOC is associated with a high risk of VTE, particularly within the first year after diagnosis. Major pelvic surgery and chemotherapy were strongly associated with VTE. Person-related risk factors were increasing age and previous VTE. Advanced stage was an independent tumor-related risk factor. These findings support the indication for thrombosis prophylaxis during chemotherapy. K E Y W O R D S deep vein thrombosis, epithelial ovarian cancer, ovarian cancer, pulmonary embolism, venous thromboembolism, venous thromboprophylaxis | 993 STRØM KAHR eT Al.

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Section: Eoc Patients (%) Asupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study

Kahr

Christiansen

Riddersholm

et al. 2021

Journal of Thrombosis and Haemostasis

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“…Approximately 3% of women with a new ovarian cancer diagnosis will have a concomitant VTE diagnosed before they start cancer treatment52; the risk of VTE approaches 12% during neoadjuvant chemotherapy55 and extends through at least the full course of primary therapy 56. The extended risk of VTE was also demonstrated in an analysis from the Million Women Study that showed the risk of VTE at 12 weeks post-operatively was 1/85 for cancer surgery and 1/365 for gynecologic surgery 57.…”

Section: Resultsmentioning

confidence: 99%

“…The risk of VTE extends beyond the traditional 30 day post-operative complication window in these patients56 71 and is inherently present among those undergoing neoadjuvant chemotherapy for ovarian cancer 55. Extended low molecular weight heparin has been shown in two randomized, placebo controlled trials in solid tumors to reduce VTE during chemotherapy by 50% 85 86.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

Nelson¹,

Bakkum-Gamez

Kalogera

et al. 2019

Int J Gynecol Cancer

523

364

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BackgroundThis is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery.MethodsA database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.ResultsAll recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly.ConclusionsThe updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.

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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 Timing of Thromboembolic Events in Patients With Ovarian Cancer Undergoing Neoadjuvant Chemotherapy

Abstract: (Abstracted from Obstet Gynecol 2017;129(6):979–985) Thromboembolism in patients with ovarian and other cancers is associated with lower survival and poor quality of life. The estimated incidence of venous thromboembolism (VTE) among patients with ovarian cancer (OC) is 10% to 22%.

Cited by 3 publications

References 0 publications

The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study

The timing of venous thromboembolism in ovarian cancer patients: A nationwide Danish cohort study

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

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

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