Poorer baseline performance status is associated with increased thromboembolism risk in metastatic cancer patients treated with immunotherapy

Thrombotic Complications Associated with Immune Checkpoint Inhibitors

“…The references in the relevant articles were also manually searched for related studies. Overall, 18 retrospective studies reporting incidences and/or outcomes of venous and/or arterial thrombosis in patients on ICIs [ 1 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] and 4 additional relevant systematic reviews and meta-analyses [ 24 , 25 , 26 , 27 ] were identified and included in this review.…”

“…In patients receiving ICIs, several studies have shown that the occurrence of thrombosis was associated with worsening survival [10,11,[20][21][22] while others have not [14][15][16] (Table 2). Possible explanations of worse survival in patients who developed VTE include that thrombosis is an indicator for more advanced cancer stage, worse prognosis, poorer performance status, and/or thrombosis or anticoagulation-related mortality.…”

“…The Khorana score was derived in a patient population starting a new line of chemotherapy, and whether it can be applied to patients on ICIs is not fully understood. Most studies that investigated the Khorana score for its prediction performance in patients receiving ICIs have not found it to be predictive [ 11 , 16 , 17 , 18 , 20 ]. This indicates that patients on ICIs likely have different sets of risk factors compared to those on chemotherapy, and a specific risk assessment model in this population may be needed.…”

“…However, most studies were small and single-center, and therefore, not surprisingly, different sets of risk factors were identified from each study, including a history of thromboembolic disease, metastasis, poor performance status, lung cancer, or melanoma, and more ( Table 2 ). It is worth noting that many of these studies tended to perform multivariable analyses with many variables from datasets with a limited number of patients and associated outcome events, leading to potential model overfit that could make results questionable [ 10 , 12 , 15 , 16 , 18 ]. Future research is needed to derive and validate a specific risk assessment model in a larger patient population receiving ICIs, which can help risk prediction and tailor thromboprophylaxis, if needed, in this growing population.…”

Table1.docx

“…A previous study showed that combined ICI therapy is significantly associated with VTE (Sussman et al, 2021). Two patients with glioblastoma multiforme, who had been treated with bevacizumab before immunotherapy, developed VTE (Guven et al, 2021). The combination of anti-VEGF therapies and ICIs needs to be investigated more as it was shown previously that for patients that received pembrolizumab combined with axitinib, VTE was unreported (Rini et al, 2019).…”