Risk Factors, Incidence, and Prognosis of Thromboembolism in Cancer Patients Treated With Immune Checkpoint Inhibitors

Abstract

In recent years, immune checkpoint inhibitors (ICIs) have become the standard treatment option for tumors. With the widespread application of ICIs, immune-related adverse events (irAEs) have gradually attracted the attention of researchers. Owing to the characteristics of ICIs, irAEs can affect each organ of the human body. Thromboembolism is uncommon in cancer patients receiving ICIs, but it may affect their survival. Most thromboembolic events do not cause serious effects after early prediction and treatment, but life-threatening toxic reactions are also observed. This condition should not be ignored because of vague and atypical symptoms, which make early diagnosis more challenging. This article focuses on the high-risk factors, underlying mechanisms, incidence, and prognosis of thromboembolism in patients using ICIs and briefly describes the intervention and treatment measures. This information would allow patients to effectively manage the side effects of thromboembolism during Immune checkpoint inhibitors treatment, ensuring the efficacy of ICIs and reducing mortality.

The Potential Role of Circulating Inflammatory Cells in Predicting the Safety, Efficacy and Immune-related Adverse Events of Immune Check-point Inhibitors: A Narrative Review

“…MDSCs can promote platelet aggregation. Also, through CXCR1/MDSCs, induce tumor to release Neutrophil Extracellular Traps (NETs) which play a significant role in thrombosis [84].…”

Evaluation of cardiovascular toxicity of the atezolizumab and bevacizumab combination

“…In the current study, we observed a trend toward a higher lethality rate of venous embolism and thrombosis when ICIs and VEGFIs were used together compared with their individual use. The mechanisms involved in the increased frequency of thromboembolism with ICIs remain unclear but include increased tissue factor production in monocytes associated with T-cell activation (Zou et al, 2021). In addition, a higher risk of venous thromboembolism has been reported in patients with c-reactive protein flares early after ICI administration (Moik et al, 2022), and increased secretion of various cytokines associated with inflammatory responses may contribute to coagulation abnormalities.…”

Interaction between NSCLC Cells, CD8+ T-Cells and Immune Checkpoint Inhibitors Potentiates Coagulation and Promotes Metabolic Remodeling—New Cues on CAT-VTE

“…Thrombotic complications in cancer patients are common [30,31] and are denominated cancer-associated thrombosis (CAT), but their risk can be influenced by the therapy applied [32][33][34]. Some studies analyzed the relationship between thromboembolic events and ICI treatment in NSCLC patients, showing, for the first time, that the risk of thrombosis is not negligible [33,[35][36][37][38][39]. Further research is needed to discover precise mechanisms underlying the interaction of hemostasis, immunological response and cancer in the context of ICI therapy [29].…”