Common cancer therapies increase VTE risk for patients with cancer, COVID-19
Click Here to Manage Email Alerts
Key takeaways:
- Exposure to common cancer treatments within 3 months before COVID-19 infection increased risk for VTE by 33%.
- Immune checkpoint inhibitor therapy appeared linked to a particularly high elevated VTE risk.
Relative risk for venous thromboembolism appeared high among patients with COVID-19 and cancer who received specific cancer treatments, according to study results published in JAMA Oncology.
The findings indicate a need for close monitoring and personalized thromboprophylaxis to prevent morbidity or mortality linked with COVID-19-associated venous thromboembolism among those with cancer, researchers concluded.
Rationale and methodology
Systematic data are limited on the association between cancer treatments and thromboembolic events among those with cancer and COVID-19, according to study background.
Shuchi Gulati, MD, MSc, assistant professor in the division of hematology and oncology in the department of internal medicine at UC Davis Comprehensive Cancer Center, and colleagues assessed the association between exposure to cancer treatment within the 3 months before COVID-19 diagnosis.
Their analysis included 4,988 people (median age, 69 years; 52% men; 51% white) hospitalized with cancer and COVID-19 infection.
Fewer than one-third of patients had metastatic cancer, 44% had active cancer, 11% had history of VTE and 34% appeared at high risk for VTE based upon Khorana score.
The most common tumor types included lung cancer (n = 472), lymphoma (n = 422), kidney cancer (n = 199), uterine cancer (n = 157), bladder cancer (n = 148), pancreatic cancer (n = 81), ovarian cancer (n = 68), gastric cancer (n = 55), esophageal cancer (n = 38) and testicular cancer (n = 35).
For the purpose of this study, treatments of interest included endocrine therapy, vascular endothelial growth factor (VEGF) inhibitors/tyrosine kinase inhibitors, immunomodulators, immune checkpoint inhibitors or chemotherapy compared with no systemic therapy within the 3 months before a COVID-19 diagnosis.
Main outcomes included VTE and arterial thromboembolism. Severity of COVID-19 infection at 30-day follow-up served as a secondary outcome.
Findings
Overall, 1,869 patients received at least one or more cancer treatments. Eleven percent of all patients studied experienced thromboembolic events (VTE, 7%; arterial thromboembolism, 4%).
VTE risk appeared highest among those who received immune checkpoint inhibitors (12%), chemotherapy (10%), VEGF inhibitors/TKIs (10%), immunomodulators (8%) or endocrine therapy (7%) compared with those who received no systemic treatments (6%).
Multivariable log-binomial regression analyses showed exposure to commonly used cancer treatments during the 3 months before COVID-19 infection appeared associated with a 33% increased risk for VTE (adjusted RR = 1.33; 95% CI, 1.04-1.69).
Researchers observed a significant association between VTE risk and immune checkpoint inhibitor therapy (adjusted RR = 1.45; 95% CI, 1.01-2.07).
Results additionally showed significant associations between VTE and active and progressing cancer (adjusted RR = 1.43; 95% CI, 1.01-2.03), history of VTE (adjusted RR = 3.1; 95% CI, 2.38-4.04) and high-risk site of cancer (adjusted RR = 1.42; 95% CI, 1.14-1.75).
Black patients appeared at higher risk than white patients for any thromboembolic event (adjusted RR = 1.24; 95% CI, 1.03-1.5).
Researchers also observed an association between occurrence of any thromboembolic event and ICU admission (46%), mechanical ventilation (31%) and high 30-day mortality rates (25%).
The risk for death after a thromboembolic event appeared higher among those exposed to cancer treatment vs. no treatment (adjusted RR = 1.12; 95% CI, 0.91-1.38), as well as among those with poor performance status (ECOG 2 adjusted RR = 1.77; 95% CI, 1.3-2.4) or those with active or progressing cancer (adjusted RR = 1.55; 95% CI, 1.13-2.13).
Researchers acknowledged study limitations, including the potential for bias and missing data for certain variables, as well as the inability to assess the association between vaccines and thromboembolic events. Only 3% of patients in the analysis had received at least one vaccine dose.
Implications
The findings highlight the need for close monitoring and personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19–related thromboembolism among patients with cancer, researchers wrote.
“Patients with cancer have a higher baseline risk [for] VTE, which is further influenced by stage, type of cancer and systemic anticancer therapies,” they wrote. “While COVID-19 has been shown to enhance the risk for thromboembolic events among patients with cancer, the contribution of systemic therapies has not been reported previously, to our knowledge. Additionally, drugs are often combined in the metastatic setting and could further enhance the risk for thromboembolic events, especially if a patient is infected with SARS-Cov-2.”
Collapse
Click Here to Manage Email Alerts