Thromboembolic events in cancer patients on active treatment with cisplatin-based chemotherapy: another look!

Abstract

BackgroundThe risk of thromboembolic events is higher among cancer patients, especially in patients undergoing chemotherapy. Cisplatin-based regimens claim to be associated with a very high thromboembolic rate. In this study, we report on our own experience with thrombosis among patients on active cisplatin-based chemotherapy.MethodsMedical records and hospital databases were searched for all the patients treated with any cisplatin-based regimen for any kind of cancer. Thrombosis was considered cisplatin-related if diagnosed any time after the first dose and up to 4 weeks after the last. The Khorana risk assessment model was performed in all cases.ResultsA total of 1677 patients (65.5% males, median age: 50 years) treated with cisplatin-based regimens were identified. Head and neck (22.9%), lung (22.2%), lymphoma and gastric (11.4% each) were the most common primary tumors. Thromboembolic events were reported in 110 (6.6%); the highest was in patients with gastric cancer (20.9%) and the lowest in patients with head and neck cancers (2.3%) and lymphoma (1.6%). Thrombosis included deep vein thrombosis (DVT) in 69 (62.7%), pulmonary embolism (PE) in 18 (16.9%) and arterial thrombosis in 17 (15.6%). A majority (51.1%) of the patients had stage IV disease and only 16% had stage I or II.In a multivariate analysis, significantly higher rates of thrombosis were associated with gastric as the primary tumor, advanced-stage disease, female sex but not age, and the Khorana risk score or type of cisplatin regimen. While the presence of CVC was significantly associated with the risk of thrombosis (p < 0.0001) in the univariate analysis, and such significance was lost in the multivariate analysis (odds ratio, 1.098; 95%CI, 0.603–1.999, p = 0.7599).ConclusionsThromboembolic events in cancer patients on active cisplatin-based chemotherapy were commonly encountered. Gastric cancer, regardless of other clinical variables, was associated with the highest risk.

Patterns and predictors of thromboembolic events among patients with gastric cancer

“…Among the whole group, thromboembolic events were confirmed in 6.6% but was highest (20.9%) in patients with gastric cancer. In multivariate analysis, significantly higher rates of thrombosis were associated with gastric, as the primary tumor, and advanced-stage disease 19 . More recently, the FLOT4 (fluorouracil plus leucovorin, oxaliplatin and docetaxel) trial also showed lower risk of thromboembolic events in the cisplatin-free regimen (FLOT4) compared to other cisplatin-containing regimens 20 .…”

Cardio-Oncology: Vascular and Metabolic Perspectives: A Scientific Statement From the American Heart Association

“…The platinum compounds such as cisplatin are alkyl-like agents that are associated with Raynaud phenomenon, hypertension, MI, stroke, arterial thrombosis, acute limb ischemia, deep vein thrombosis (DVT), and pulmonary embolism. 31–34 Furthermore, chest pain has been reported in as many as 38% of patients with testicular cancer treated with cisplatin in combination with vinca alkaloids and bleomycin. 25 These adverse events are likely the result of direct toxic effects on endothelial cells, platelet activation, and decreased nitric oxide availability.…”

Thromboembolic events in metastatic testicular cancer treated with cisplatin-based chemotherapy

“…The Khorana score is a predictive model for chemotherapy-associated TEE and is based on the following: (1) Site of cancer; (2) Prechemotherapy platelet count 350 × 10 9 /L or more; (3) Hemoglobin level less than 100 g/L or use of red cell growth factors; (4) Prechemotherapy leukocyte count more than 11 × 10 9 /L; and (5) BMI 35 kg/m 2 or more[ 2 , 20 , 21 ]. The risk of TEE is 4-6-fold higher in patients with cancer than in those without, and the TEE incidence is 3%-15% annually in cancer patients[ 14 , 18 ].…”

“…According to the American Cancer Society, approximately 9610 new cases of testicular cancer will be diagnosed in 2020 with 440 deaths[ 1 ]. One in every 250 males will develop testicular cancer during their lifetime[ 1 , 2 ]. With the emergence of cisplatin-based chemotherapy in the 1970’s[ 3 ], patients with testicular cancer are able to attain a 5-year survival rate of more than 95%[ 1 , 4 , 5 ].…”