Venous Thromboembolic Events in Germ Cell Cancer Patients Undergoing Platinum-Based Chemotherapy

Honecker, Friedemann; Koychev, Daniel; Luhmann, Anna D; Länger, Florian; Dieckmann, Klaus‐Peter; Bokemeyer, Carsten; Oechsle, Karin

doi:10.1159/000355652

Cited by 26 publications

(49 citation statements)

References 26 publications

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“…The slight discrepancies between our TEE frequencies and others may be because we conducted thorough retrospective analyses and have access to superbly managed and deep institutional EMR and an innovative research data warehouse as well as differences in the complexity of patient cohorts. Worth noting is that in prior cohort analyses, 19% of TEEs occurred exclusively in patients treated with cisplatin-containing regimen [15]. This finding is in line with our data, which revealed TEEs only in those patients undergoing cisplatin-based polychemotherapy.…”

Section: Discussionsupporting

confidence: 91%

“…In our cohort, half the patients received limited LMWH prophylaxis and the other half extended LMWH prophylaxis beyond hospitalization. In our study, 22 out of 93 (23.7%) GCC patients undergoing chemotherapy presented with a TEE, primarily venous events consistent with previous studies [1,5,13,14,15,16,17,18,19]. None were fatal.…”

Section: Discussionsupporting

confidence: 90%

“…To the best of our knowledge, the cohort we studied is the largest described to date in conjunction with GCC comparing the effect of extended vs. limited LMWH prophylaxis during cisplatin-containing chemotherapy. In previous GCC studies, the reported rate of TEE was between 7 and 19% [13,14,15,16,17]. The absolute numbers of TEE found in our cohort - independent of the treatment groups (limited prophylaxis: 10/48 (20.8%) and extended prophylaxis: 12/45 (26.7%)) - are higher than those described so far [13,14,15,16,17].…”

Section: Discussioncontrasting

confidence: 64%

“…In previous GCC studies, the reported rate of TEE was between 7 and 19% [13,14,15,16,17]. The absolute numbers of TEE found in our cohort - independent of the treatment groups (limited prophylaxis: 10/48 (20.8%) and extended prophylaxis: 12/45 (26.7%)) - are higher than those described so far [13,14,15,16,17]. Moreover, they are higher than those reported in the largest retrospective analysis published by Honecker et al [15], which involved 193 GCC patients treated with platinum-based chemotherapy (cisplatin or carboplatin).…”

Section: Discussionmentioning

confidence: 99%

“…Studies on patients with GCC specifically report TEE rates between 7 and 19% during cisplatin-based chemotherapy [13,14,15,16,17]. Evidence is based on numerous retrospective case reports [18,19,20] and a few larger series [13,14,15,16,17]. In their investigation of over 8,200 patients with various solid tumor entities from 38 institutions between 1990 and 2010, Seng et al (2012) reported an overall dose-dependent incidence of TEE of 1.92% in patients receiving cisplatin-based chemotherapy compared to 0.79% in those not given cisplatin [21].…”

Section: Introductionmentioning

confidence: 99%

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High Rates of Thromboembolic Events in Patients with Germ Cell Cancer Undergoing Cisplatin-Based Polychemotherapy

Solari¹,

Krönig

Ihorst³

et al. 2016

Urol Int

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Background: We examined whether or not extended prophylaxis with low molecular weight heparin (LMWH) would significantly reduce thromboembolic event (TEE) rates in germ cell cancer patients undergoing cisplatin-based chemotherapy. Patients and Methods: LMWH prophylaxis was given from the first day of chemotherapy until 21 days after completing the last chemotherapy cycle to 45 out of 93 (48.4%) patients (extended), and to 48 out of 93 (51.6%) patients during their hospitalization only (limited) between January 2008 and December 2013. Patients were analyzed retrospectively for TEEs such as deep vein thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI) or peripheral arterial thrombosis. Results: A total of 22/93 (23.7%) patients experienced 30 TEE during chemotherapy: 12 out of 30 (40%) deep vein thrombosis, 4 out of 30 (13.3%) MI, 10 out of 30 (33.3%) PE and 4 out of 30 peripheral arterial thrombosis (13.3%). TEE rates in both groups did not differ significantly (extended: 26.7 vs. limited: 20.8%). Conclusions: The introduction of extended LMWH prophylaxis did not significantly reduce TEE rates in our patient cohort.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

High Rates of Thromboembolic Events in Patients with Germ Cell Cancer Undergoing Cisplatin-Based Polychemotherapy

Solari¹,

Krönig

Ihorst³

et al. 2016

Urol Int

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Large retroperitoneal lymphadenopathy and increased risk of venous thromboembolism in patients receiving first‐line chemotherapy for metastatic germ cell tumors: A study by the global germ cell cancer group (G3)

Ruíz-Morales

González-Billalabeitia

Patrikidou

et al. 2019

Cancer Medicine

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BackgroundMetastatic germ cell tumor (mGCT) patients receiving chemotherapy have increased risk of life‐threatening venous thromboembolism (VTE). Identifying VTE risk factors may guide thromboprophylaxis in this highly curable population.MethodsData were collected from mGCT patients receiving first‐line platinum‐based chemotherapy at 22 centers. Predefined variables included International Germ Cell Cancer Collaborative Group (IGCCCG) risk classification, long‐axis diameter of largest retroperitoneal lymph node (RPLN), Khorana score, and use of indwelling vascular access device (VAD). VTE occurring at baseline, during chemotherapy and within 90 days, was analyzed.ResultsData from 1135 patients were collected. Median age was 31 years (range 10‐74). IGCCCG risk was 64% good, 20% intermediate, and 16% poor. VTE occurred in 150 (13%) patients. RPLN >3.5 cm demonstrated highest discriminatory accuracy for VTE (AUC 0.632, P < .001) and was associated with significantly higher risk of VTE in univariable analysis (22% vs 8%, OR 3.0, P < .001) and multivariable analysis (OR 1.8, P = .02). Other significant risk factors included, Khorana score ≥3 (OR 2.6, P = .008) and VAD use (OR 2.7, P < .001).ConclusionsLarge RPLN and VAD use are independent risk factors for VTE in mGCT patients receiving chemotherapy. VAD use should be minimized in this population and thromboprophylaxis might be considered for large RPLN.

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

et al. 2023

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BackgroundGerm cell tumours (GCT) are highly curable malignancies. Venous thromboembolism (VTE) is a serious complication, needing better risk assessment models (RAM).AimIdentification of VTE incidence and risk factors in metastatic GCT patients starting first‐line chemotherapy. Developing a RAM and comparing it to Khorana risk score (KRS) and Padua Prediction Score (PPS).Material and methodsWe retrospectively analysed GCT patients staged IS–IIIC. VTE risk factors were identified with logistic regression. Area under curve of receiver operating characteristic (AUC‐ROC), Akaike and Bayesian Information Criteria (AIC, BIC) were calculated for the developed RAM, KRS and PPS.ResultsAmong 495 eligible patients, VTE occurred in 69 (13.9%), including 40 prior to chemotherapy. Vein compression (OR: 8.96; 95% CI: 2.85–28.13; p < 0.001), clinical stage IIIB‐IIIC (OR: 5.68; 95% CI: 1.82–17.70; p = 0.003) and haemoglobin concentration (OR for 1 g/dL decrease: 1.32; 95% CI: 1.03–1.67; p = 0.026) were significant in our RAM. KRS ≥ 3 (OR: 3.31; 95% CI: 1.77–6.20; p < 0.001), PPS 4–5 (OR: 3.06; 95% CI: 1.49–6.29; p = 0.002) and PPS > 5 (OR 8.05; 95% CI 3.79–17.13; p < 0.001) correlated with VTE risk. Diagnostic criteria (AUC‐ROC, AIC, BIC) for the developed RAM, KRS and PPS were (0.885; 0.567; −1641), (0.588; 0.839; −1576) and (0.700; 0.799; −1585), respectively. In the numerical score, the optimal cut‐off point for high‐risk was ≥9, with sensitivity, specificity, positive and negative predictive value of 0.78, 0.77, 0.35 and 0.96, respectively.ConclusionsOur RAM, based on vein compression, clinical stage and haemoglobin concentration proved superior to both KRS and PPS. VTE is frequent in GCT patients.

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Venous Thromboembolic Events in Germ Cell Cancer Patients Undergoing Platinum-Based Chemotherapy

Cited by 26 publications

References 26 publications

High Rates of Thromboembolic Events in Patients with Germ Cell Cancer Undergoing Cisplatin-Based Polychemotherapy

High Rates of Thromboembolic Events in Patients with Germ Cell Cancer Undergoing Cisplatin-Based Polychemotherapy

Large retroperitoneal lymphadenopathy and increased risk of venous thromboembolism in patients receiving first‐line chemotherapy for metastatic germ cell tumors: A study by the global germ cell cancer group (G3)

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

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