Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours

Gizzi, Marco; Obéric, Lucie; Massard, Christophe; Poterie, Audrey; Teuff, Gwénaël Le; Loriot, Yohann; Albigès, Laurence; Baciarello, Giulia; Michels, Judith; Bossi, Alberto; Blanchard, Pierre; Escudier, Bernard; Fizazi, Karim

doi:10.1016/j.ejca.2016.10.003

Cited by 35 publications

(53 citation statements)

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“…We may hypothesize that this difference is related to the type of tumor and related chemotherapy. The most frequent neoplasm among young men is the germ cell tumor, which is treated with cisplatin‐based chemotherapy, with a high risk of thromboembolic events . Finally, we found that open‐system PICCs conferred a higher risk of AEs than valved‐system PICCs.…”

Section: Discussionmentioning

confidence: 62%

Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days

Campagna¹,

Gonella

Berchialla

et al. 2019

The Oncologist

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Background Peripherally inserted central catheters (PICCs) are central venous catheters (CVCs) that are commonly used in onco‐hematologic settings for chemotherapy administration. As there is insufficient evidence to recommend a specific CVC for chemotherapy administration, we aimed to ascertain PICC‐related adverse events (AEs) and identify independent predictors of PICC removal in patients with cancer receiving chemotherapy. Materials and Methods Information on adult patients with cancer with a PICC inserted for chemotherapy administration between September 2007 and December 2014 was extracted from six hospital databases. The primary outcome was PICC removal due to PICC‐related AEs (occlusion, infection, or symptomatic thrombosis). Independent predictors of PICC removal were identified using a multivariate Cox regression model. Results Among the 2,477 included patients, 419 PICC‐related AEs (16.9%; 1.09 AEs per 1,000 PICC‐days) were reported. AEs increased when PICC was inserted at the brachial site (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.02–1.84) and with open systems (HR, 1.89; 95% CI, 1.24–2.88) and decreased in older men (HR, 0.63; 95% CI, 0.49–0.81). Conclusion Use of PICC for chemotherapy administration was associated with a low all‐AEs rate. The basilic vein was the safer site, and valved systems had fewer AEs than open systems. More research is needed to explore the interaction between AEs, sex, and age. Implications for Practice These findings provide clinicians with evidence that peripherally inserted central catheters (PICCs) are safe for chemotherapy administration. They also suggest that clinicians should limit the use of open systems when long chemotherapy regimens are scheduled. Moreover, alternatives to PICCs should be considered when administering chemotherapy to young men.

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Section: Discussionmentioning

confidence: 62%

Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days

Campagna¹,

Gonella

Berchialla

et al. 2019

The Oncologist

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“…Some case reports have described severe acute myocardial infarction or stroke shortly after chemotherapy in TC survivors, although these events are rare and usually not fatal. Differences in the underlying CVD risk factors, lifestyles, and prophylactic use of low‐molecular‐weight heparin to prevent platinum‐associated thromboembolic events may underlie these heterogeneous findings with respect to CVD mortality …”

Section: Discussionmentioning

confidence: 99%

Platinum exposure and cause‐specific mortality among patients with testicular cancer

Groot

Leeuwen

Lubberts

et al. 2019

Cancer

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BACKGROUND: Although testicular cancer (TC) treatment has been associated with severe late morbidities, including second malignant neoplasms (SMNs) and ischemic heart disease (IHD), cause-specific excess mortality has been rarely studied among patients treated in the platinum era. METHODS: In a large, multicenter cohort including 6042 patients with TC treated between 1976 and 2006, causespecific mortality was compared with general population mortality rates. Associations with treatment were assessed with proportional hazards analysis. RESULTS: With a median follow-up of 17.6 years, 800 patients died; 40.3% of these patients died because of TC. The cumulative mortality was 9.6% (95% confidence interval [CI], 8.5%-10.7%) 25 years after TC treatment. In comparison with general population mortality rates, patients with nonseminoma experienced 2.0 to 11.6 times elevated mortality from lung, stomach, pancreatic, rectal, and kidney cancers, soft-tissue sarcomas, and leukemia; 1.9-fold increased mortality (95% CI, 1.3-2.8) from IHD; and 3.9-fold increased mortality (95% CI, 1.5-8.4) from pneumonia. Seminoma patients experienced 2.5 to 4.6 times increased mortality from stomach, pancreatic, bladder cancer and leukemia. Radiotherapy and chemotherapy were associated with 2.1 (95% CI, 1.8-2.5) and 2.5 times higher SMN mortality (95% CI, 2.0-3.1), respectively, in comparison with the general population. In a multivariable analysis, patients treated with platinum-containing chemotherapy had a 2.5-fold increased hazard ratio (HR; 95% CI, 1.8-3.5) for SMN mortality in comparison with patients without platinum-containing chemotherapy. The HR for SMN mortality increased 0.29 (95% CI, 0.19-0.39) per 100 mg/m 2 platinum dose administered (P trend < .001). IHD mortality was increased 2.1-fold (95% CI, 1.5-4.2) after platinum-containing chemotherapy in comparison with patients without platinum exposure. CONCLUSIONS: Platinum-containing chemotherapy is associated with a dosedependent increase in the risk of SMN mortality. Cancer 2020;126:628-639.

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“…(RR = 0.56, 95% CI 0.47-0.68) [13] Gizzi et al studied the incidence of thromboembolic events in GCT patients treated with rst-line chemotherapy and observed lower incidence of thromboembolic events in patients receiving thromboprophylaxis when compared to patients without prophylaxis. [12] However, small number of patients in each subgroup of this study makes the interpretation of the results di cult and larger study is needed to elucidate the relationship between thromboprophylaxis and incidence of VTE in GCT patients undergoing cisplatin-based chemotherapy.…”

Section: Introductionmentioning

confidence: 94%

“…[6] Several groups focused on identi cation of risk factors of VTE events in GCT patients. [6,[9][10][11][12] Weijl et al observed an increased risk of VTE in patients with liver metastases (odds ratio = 4.9). [10] Piketty et al identi ed body surface area > 1.9m 2 (relative risk (RR) = 5, 95% con dence interval (CI) 1.8-13.9) and elevated serum lactate dehydrogenase (RR = 6.4, 95% CI 2.3-18.2) as independent risk factors.…”

Section: Introductionmentioning

confidence: 99%

Effect of prophylactic anticoagulation on the incidence of venous thromboembolism in patients with testicular germ cell tumor.

Hapakova

Chovanec

Rejleková

et al. 2020

Preprint

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Background Testicular germ cell tumors (GCTs) are among the most common solid tumors in young males. With the availability of highly effective treatment, improving patients’ quality of life has gained more focus in recent years. Venous thromboembolism (VTE), commonly occurring in patients with GCT, is associated with increased morbidity and mortality. Prophylactic anticoagulation has been shown to decrease the risk of VTE in patients with malignancy. The aim of this retrospective study was to evaluate the effect of low-molecular-weight heparin (LMWH) prophylaxis on the incidence of VTE and outcome in patients with GCT treated with first-line chemotherapy. Methods Our study population included chemotherapy-naive patients with GCT treated with first-line chemotherapy at the National Cancer Institute, Bratislava, Slovakia, from January 2000 to December 2017. VTE was defined as any venous thrombosis or pulmonary embolism, confirmed by imaging, occurring during first-line chemotherapy. Patients diagnosed with VTE on initial staging exam were excluded from the study. No visceral thromboses were observed. Results Our cohort included 353 patients with GCT. LMWH prophylaxis was administered to 104 patients (29.5%), and 249 patients (70.5%) did not receive prophylaxis. We observed 14 (4.0%) VTE events. The difference in VTE incidence between patients with and without prophylaxis was not statistically significant (5.8% vs. 3.2% P = 0.37). We observed a trend toward longer overall survival in patients without prophylaxis (hazard ratio = 0.61, 95% confidence interval = 0.32-1.13, p = 0.08). Patients with extragonadal GCT receiving VTE prophylaxis had significantly shorter survival (hazard ratio = 0.29, 95% confidence interval = 0.08-1.12, P = 0.04). This effect was most likely driven by a higher incidence of treatment-related deaths in patients with extragonadal GCT receiving LMWH ( P = 0.06). Conclusions LMWH prophylaxis was not associated with decreased VTE incidence.Moreover, there was a higher incidence of treatment-related deaths in patients with extragonadal tumor location. LMWH prophylaxis during hospitalization should not be used routinely in patients with GCT receiving chemotherapy.

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Predicting and preventing thromboembolic events in patients receiving cisplatin-based chemotherapy for germ cell tumours

Cited by 35 publications

References 30 publications

Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days

Can Peripherally Inserted Central Catheters Be Safely Placed in Patients with Cancer Receiving Chemotherapy? A Retrospective Study of Almost 400,000 Catheter-Days

Platinum exposure and cause‐specific mortality among patients with testicular cancer

Effect of prophylactic anticoagulation on the incidence of venous thromboembolism in patients with testicular germ cell tumor.

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