Venous thromboembolism and nonsmall cell lung cancer

Abstract

BACKGROUND:Advanced nonsmall cell lung cancer (NSCLC) is associated with venous thromboembolism (VTE). However, to the authors' knowledge, the incidence of VTE in early NSCLC, predictors of VTE, and the prognostic significance of VTE in NSCLC have not been explored.METHODS:Individual patient data from 3 National Cancer Institute of Canada Clinical Trials Group trials were analyzed (n = 1987 patients). Clinical Trial BR.10 was a randomized study of postoperative vinorelbine and cisplatin versus observation in patients with stage IB/II NSCLC (grading determined according to the TNM staging system). Clinical Trial BR.18 was a randomized study of paclitaxel and carboplatin with or without the metalloproteinase inhibitor BMS‐275291 in patients with advanced NSCLC. BR.21 was a randomized study of erlotinib versus placebo in patients with previously treated NSCLC. The relations between VTE, treatment, concomitant medications, and patient characteristics were explored in univariate and multivariate analyses. Survival analysis was completed using Cox regression.RESULTS:The incidence of VTE ranged from 0% in patients with early stage NSCLC on the observation arm of BR.10 to 7.9% in patients with advanced NSCLC who received chemotherapy (BR.18). Patients with early stage NSCLC who received chemotherapy (BR.10) and patients with previously treated NSCLC who received erlotinib or placebo (BR.21) had a VTE incidence of ∼3%. Factors that were found to be predictive of VTE included previous VTE (BR.18; P = .001) and obesity (BR.10; P = .03). In patients with advanced NSCLC, VTE was associated with shorter survival (BR.18: hazard ratio [HR], 1.61; 95% confidence interval [95% CI], 1.26‐2.07 [P = .0002]; BR.21: HR, 2.18; 95% CI, 1.57‐3.04 [P < .0001]).CONCLUSIONS:In patients with both early stage and advanced stage NSCLC, VTE occurred more frequently in patients who received chemotherapy (but not erlotinib or BMS‐275291). In patients with advanced stage NSCLC, VTE was associated with obesity and a history of VTE. VTE was found to be prognostic in patients with advanced stage NSCLC. Cancer 2009. © 2009 American Cancer Society.

Early venous thromboembolic events are associated with worse prognosis in patients with lung cancer

“…The incidence of VTE in this study is similar to what has been reported in the literature [5,21]. Although this incidence is not as high as in other solid malignancies (e.g.…”

“…VTE have been associated with worse prognosis among patients with solid malignancies [5,6], although it remains unclear whether VTE constitute an independent predictor of worse survival in this patient population or merely represent surrogates of more advanced malignancies overall. Primary prevention is effective in decreasing the incidence of cancer associated VTE [7]; however, the optimal timing and patient population that would most benefit from outpatient thromboprophylaxis is not well defined [8,9].…”

Current evidence of rivaroxaban in cancer-associated thrombosis

“…VTE is one of the leading causes of death in this population, and negatively impacts treatment outcome [24][25][26][27][28]. The survival in cancer patients and diagnosed with VTE is lower (up to three times) when compared with cancer patients with no thrombosis [8,29].…”

Venous Thromboembolic Disease

“…A history of VTE has been identified in several studies as an independent risk factor for developing a subsequent VTE. 14,23,26–29 Moreover, recurrent VTE was found to be more common among patients with cancer; for example, 12-month cumulative incidences of 20.7% and 6.8% of recurrent VTE were reported for patients with and without cancer, respectively, undergoing anticoagulant treatment. 30 Although factor V Leiden and prothrombin mutations were identified in 3.7% and 2.6%, respectively, of patients with breast or colon cancer undergoing adjuvant chemotherapy in a recent prospective observational study, these inherited risk factors were not associated with an increased risk of VTE among cancer patients.…”

“…27,33 Furthermore, researchers have reported cancer as the cause of approximately 20% of the VTE cases seen in the community, 3 and a recent cancer diagnosis and the occurrence of advanced malignancies and distant metastases also increase VTE risk. 2,23,31,34,35 For example, Blom et al 31 reported an adjusted odds ratio (OR) of 19.8 for VTE risk in patients with solid tumors with distant metastases compared with those without. In addition, tumor histology has been shown to influence the risk of VTE in patients.…”