Venous and arterial thrombosis in patients who received adjuvant therapy for breast cancer.

Abstract

The records of 2,673 patients randomized according to seven consecutive Eastern Cooperative Oncology Group (ECOG) studies of adjuvant therapy for breast cancer were reviewed for the occurrence of vascular complications. All protocols opened and closed between June 1977 and July 1987. The objectives of the present study were (1) to compare the frequency of vascular complications among patients who received adjuvant therapy for breast cancer with patients on observation, and (2) to estimate the contribution of chemotherapy and hormonal therapy to the occurrence of venous and arterial thrombi. The frequency of thrombosis, both venous and arterial combined, was 5.4% among patients who received adjuvant therapy and was 1.6% among patients on observation (P = .0002). Premenopausal patients who received chemotherapy and tamoxifen had significantly more venous complications than those who received chemotherapy without tamoxifen (2.8% v 0.8%, P = .03). Postmenopausal patients who received tamoxifen and chemotherapy had significantly more venous thrombi than those who received tamoxifen alone (8.0% v 2.3%, P = .03) or those who were observed (8.0% v 0.4%, P less than .0001). Premenopausal patients who received tamoxifen and chemotherapy had a 1.6% frequency of arterial thrombosis, significantly more than patients who received chemotherapy alone (1.6% v 0.0%, P = .004). The frequency of arterial thrombosis among postmenopausal patients was not significantly correlated with adjuvant therapy. In conclusion, patients who received adjuvant therapy for breast cancer had a 5.4% frequency of thromboembolic complications, significantly more than those who were observed. The combination of chemotherapy and tamoxifen was associated with more venous and arterial thromboembolic complications than chemotherapy alone in premenopausal patients and with more venous thrombi than tamoxifen alone among postmenopausal patients.

Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating antithrombopoietin antibodies

“…Ten of the 186 adult patients (5%) had experienced 1 or more thrombotic/ischemic events, a rate, which is comparable to the 5% incidence of thrombotic events in patients with cancer, a group known to be at high risk for thrombosis [31,32]. The incidence of thrombotic events in the adult patients of age <65 years was as high as that in the overall group at 7/149 (5%).…”

Venous thromboembolism and nonsmall cell lung cancer

“…17 Other drugs that are used frequently in both cancer and noncancer patients, particularly hormones 18,19 and erythropoietin, [20][21][22] are associated with an increased risk of VTE in the malignant setting. [5][6][7] In the current series, few patients were receiving hormone therapy, most likely because of the nature of the lung cancer population; therefore, we did not identify an association with the use of oral contraceptives or hormone-replacement therapy. Similarly, only 2 patients received with erythropoietin; however, it is interesting to note that 1 of those patients did experience VTE.…”

“…In breast cancer, both adjuvant chemotherapy and hormone therapy increase the risk of VTE. [5][6][7][8] In myeloma, thalidomide increases the risk of VTE, particularly when administered with chemotherapy or dexamethasone. 9,10 By using registry data, Chew et al reported a 1-year cumulative incidence of VTE of 3% for patients with all stages of NSCLC and small cell lung cancer.…”

Cancer-Associated Thrombosis

“…The strongest clinical relationship between chemotherapy and thrombosis was found in patients with breast cancer receiving chemotherapy [10,[12][13][14][15]. In a study by the Eastern Cooperative Oncology Group, VTE was significantly more common in patients with *Address correspondence to this author at the Hematology Research Center, Nemazee Hospital of Shiraz University of Medical Sciences, Zand st, Shiraz, Iran; Tel/Fax: +98 711 6473239; E-mail: Karimim@sums.ac.ir breast cancer who underwent chemotherapy and hormonal therapy than in the control group [16]. A high incidence of VTE following chemotherapy was also reported in other cancers [17,18].…”

“…Certain malignancies, particularly mucin-secreting adenocarcinomas of the ovary, pancreas, stomach, brain tumors and hematological malignancies, are associated with a higher risk of VTE [12][13][14][15][16]. Some conditions are well-known risk factors for increased risk of thrombosis in patients with cancer.…”