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

Abstract

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.

Simple yet (more?) effective. Venous thromboembolism risk assessment model for germ cell tumour patients receiving first‐line chemotherapy

“…Interestingly, 58% VTE cases in our group were diagnosed prior to chemotherapy. Other authors usually reported contrary results; pre‐treatment VTE accounted for 13.0%–44.7% of all events 15,18,21–23,25,30 . In the group of Honecker et al, 14 81% of VTE cases occurred before first‐ or second‐line chemotherapy.…”

“…19 In the study of Heidegger et al, only 7.7% of VTE cases occurred in patients scoring ≥3, 17 which was less than in the above-mentioned metaanalysis. 42 Other authors 21,43 did not show a correlation between KRS and VTE risk in GCT patients at all. PPS < 4 and ≥4 identify low and high VTE risk patients, respectively.…”

Cisplatin for cancer therapy and overcoming chemoresistance

“…A retrospective study of the testicular germ cell tumours had high cure rates from cisplatin therapy in men (aged between 18-39). It revealed predisposition to thromboembolic events in higher pathological stages (such as the stage III carcinoma), and had been exposed to a greater number of treatment cycles for which prophylactic treatment with anti-coagulants was required [ 109 ].…”

Seratrodast platinum(iv) hybrids efficiently inhibit cancer-related thrombosis and metastasis phenotype in vitro and in vivo

“…12 Epidemiological investigations found that approximately 10-57% of malignant tumor patients have elevated platelets; 13 the probability of VTE occurring in cancer patients is 4-8 times higher, [14][15][16] and the risk of death from cardiovascular disease is 5-7 times higher than that of the general population. 17,18 Alcalay et al also reported that VTE incidence in colorectal cancer (CRC) patients after diagnosis was close to 5% and as high as 20% in metastatic cancer. 19 Besides, up to 37% of chemotherapy patients (especially with cisplatin) experience Raynaud's phenomenon, with 25% continuing for more than 20 years after treatment.…”