Recommendations to Balance Benefits and Risks Of Thromboprophylaxis and to Avoid Central Venous-access Devices During First-line Chemotherapy in Men with Metastatic Germ Cell Tumors: The European Association Of Urology Testicular Cancer Panel Position in 2021

Fankhauser, Christian Daniel; Oldenburg, Jan; Albers, Peter; Algaba, Ferrán; Bokemeyer, Carsten; Boormans, Joost L.; Fischer, Stefanie; Fizazi, Karim; Gremmels, Hendrik; Castro, J. Mayor de; Janisch, Florian; Muilwijk, Tim; Leão, Ricardo; Nicol, David; Nicolai, Nicola; Tandstad, Torgrim; Laguna, M. Pilar

doi:10.1016/j.eururo.2021.02.032

Cited by 6 publications

(6 citation statements)

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“…Although the American Society of Clinical Oncology clinical practice guideline recommends thromboprophylaxis with DOACs or LMWH to selected high-risk ambulatory patients [32] , no data from randomized trials support the routine use in TC patients, as the fraction of TC patients in recent trials was very small (<1%). Owing to the paucity of randomized data, a recent European Association of Urology guideline recommends balancing each patient’s benefits and risk of thromboprophylaxis [33] . In line with previous reports [9] , [11] , thromboprophylaxis did not reduce the incidence of VTE in our study, possibly due to the selection of patients with VTE risk factors for thromboprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

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Thromboembolic Events During Treatment with Cisplatin-based Chemotherapy in Metastatic Testicular Germ-cell Cancer 2000–2014: A Population-based Cohort Study

Haugnes

Negaard

Jensvoll

et al. 2021

European Urology Open Science

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Background Cisplatin-based chemotherapy (CBCT) in testicular cancer (TC) is associated with elevated venous thromboembolism (VTE) risk, but trials evaluating the safety and efficacy of thromboprophylaxis are lacking. Objective To evaluate the arterial thromboembolism (ATE) and VTE incidence and risk factors during first-line CBCT for metastatic TC, and the effect of thromboprophylaxis on VTE and bleeding. Design, setting, and participants In a population-based study, 506 men administered first-line CBCT during 2000–2014 at three university hospitals in Norway were included. Clinical variables were retrieved from medical records. Outcome measurements and statistical analysis Patients with ATE and VTE diagnosed at initiation of or during CBCT until 3 mo after completion were registered. Age-adjusted logistic regression was performed to identify possible VTE risk factors. Results and limitations Overall, 69 men (13.6%) were diagnosed with 70 thromboembolic events. Twelve men (2.4%) experienced ATE. Overall, 58 men (11.5%) experienced VTE, of whom 13 (2.6%) were prevalent at CBCT initiation, while 45 (8.9%) were diagnosed with incident VTE. Age-adjusted logistic regression identified retroperitoneal lymph node metastasis >5 cm (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.01–3.91), central venous access (OR 2.84, 95% CI 1.46–5.50), and elevated C-reactive protein (>5 mg/l; OR 2.38, 95% CI 1.12–5.07) as incident VTE risk factors. Thromboprophylaxis ( n = 84) did not influence the risk of VTE (VTE incidence with or without prophylaxis 13% vs 8%, p = 0.16). The incidence of bleeding events was significantly higher among those who received thromboprophylaxis than among those without thromboprophylaxis (14.5% vs 1.1%, p < 0.001). Conclusions We found a high rate of thromboembolism incidence of 13.6%. Thromboprophylaxis did not decrease the risk of VTE but was associated with an increased risk of bleeding. Patient summary We found a high rate of thromboembolism (13.6%) during cisplatin-based chemotherapy for metastatic testicular cancer. Prophylactic treatment against thromboses did not reduce the thrombosis frequency, but it resulted in a high incidence of bleeding events.

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Section: Discussionmentioning

confidence: 99%

“…Given the high incidence of bleeding and the fact that VTE in this patient population did not influence survival, thromboprophylaxis should be considered only in selected patients. The most important risk factor for incident VTE seems to be central venous access use, which should be avoided in routine clinical practice [33] .…”

Section: Discussionmentioning

confidence: 99%

Thromboembolic Events During Treatment with Cisplatin-based Chemotherapy in Metastatic Testicular Germ-cell Cancer 2000–2014: A Population-based Cohort Study

Haugnes

Negaard

Jensvoll

et al. 2021

European Urology Open Science

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“…Im Rahmen dieser Single-center-Analyse mit 279 Männer konnte beobachtet werden, dass sich mit forcierter Implementierung der prophylaktischen Antikoagulation mit NHM ab dem Jahr 2005 die Inzidenz von thromboembolischen Komplikationen ungefähr halbierte [5]. Das EAU-Panel klassifizierte Patienten mit einem metastasierten Keimzelltumor unter Chemotherapie als solche mit einem hohen VTE-Risiko und geringen Blutungsrisiko, gibt jedoch auf Grund der fehlenden Datenlage keine klaren Empfehlungen zur Thromboseprophylaxe, sondern empfiehlt eine individuelle Therapieentscheidung basierend auf den potenziellen Benefits und Risiken [36]. Eine schwache Empfehlung besteht in der Vermeidung von ZVKs zur Chemotherapieapplikation bei TGCT [36].…”

Section: üBersichtunclassified

“…Das EAU-Panel klassifizierte Patienten mit einem metastasierten Keimzelltumor unter Chemotherapie als solche mit einem hohen VTE-Risiko und geringen Blutungsrisiko, gibt jedoch auf Grund der fehlenden Datenlage keine klaren Empfehlungen zur Thromboseprophylaxe, sondern empfiehlt eine individuelle Therapieentscheidung basierend auf den potenziellen Benefits und Risiken [36]. Eine schwache Empfehlung besteht in der Vermeidung von ZVKs zur Chemotherapieapplikation bei TGCT [36].…”

Section: üBersichtunclassified

“…Das EAU-Panel empfiehlt bei Keimzelltumorpatienten eine Verwendung von NMH oder eine orale Thromboseprophylaxe z. B. mittels Apixaban 2,5 mg (1-0-1) oder Rivaroxaban 10 mg/Tag vor Beginn der Chemotherapie für insgesamt 90 Tage [36]. Zudem sollten ambulante Patienten, bei denen eine Tumortherapie vorgesehen ist, detaillierte Informationsmaterialien Aufklärung über VTE, einschließlich Risikofaktoren und Symptome erhalten.…”

Section: Ambulante Tumorpatientenunclassified

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Thrombembolie-Risikofaktoren und Prophylaxe

Paffenholz

2023

Aktuelle Urol

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Zusammenfassung Venöse Thromboembolien stellen eine wichtige Komplikation bei Tumorpatienten, da sie bei diesen Patienten gehäuft auftreten und eine relevante Morbidität bedingen. Das Risiko für thromboembolische Komplikationen bei Tumorpatienten liegt 3–9-mal höher als bei Nichttumorpatienten und stellt die zweithäufigste Todesursache bei Tumorpatienten dar. Das Thromboserisiko hängt neben der tumorinduzierten Koagulopathie von individuellen Faktoren, der Art und dem Stadium der Krebserkrankung, der Zeit seit der Krebsdiagnose sowie der Art einer systemischen Krebstherapie ab. Eine Thromboseprophylaxe bei Tumorpatienten ist wirksam, kann jedoch mit erhöhten Blutungen einhergehen. Auch wenn dezidierte Empfehlungen für einzelne Tumorentitäten aktuell nicht vorliegen, empfehlen internationale Leitlinien prophylaktische Maßnahmen bei Hochrisikopatienten. So kann ein Thromboserisiko von >8–10% als Indikation für eine Thromboseprophylaxe angesehen werden. Dieses Risiko wurde bei Patienten mit einem Khorana-Score von ≥2 erreicht und sollte individuell mithilfe der Nomogramme berechnet werden. Vor allem bei Patienten mit geringem Blutungsrisiko wird diese Empfehlung ausgesprochen. Während des Arztgesprächs sollten zudem Risikofaktoren und Symptome eines thromboembolischen Events thematisiert und Materialien zur Patientenaufklärung ausgehändigt werden.

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SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023)

Arranz Arija,

del Muro,

Caro

et al. 2024

Clin Transl Oncol

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Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.

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Recommendations to Balance Benefits and Risks Of Thromboprophylaxis and to Avoid Central Venous-access Devices During First-line Chemotherapy in Men with Metastatic Germ Cell Tumors: The European Association Of Urology Testicular Cancer Panel Position in 2021

Cited by 6 publications

References 10 publications

Thromboembolic Events During Treatment with Cisplatin-based Chemotherapy in Metastatic Testicular Germ-cell Cancer 2000–2014: A Population-based Cohort Study

Thromboembolic Events During Treatment with Cisplatin-based Chemotherapy in Metastatic Testicular Germ-cell Cancer 2000–2014: A Population-based Cohort Study

Thrombembolie-Risikofaktoren und Prophylaxe

SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023)

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