Immune checkpoint inhibitors for advanced lung cancer linked to higher blood clot risk
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Key takeaways:
- Treatment with any immune checkpoint inhibitor increased venous thromboembolism risk for adults with metastatic lung cancer.
- Those who received anti-PD-1 therapy had higher risk for pulmonary embolism than those who received anti-PD-L1 agents.
Treatment with immune checkpoint inhibitors appeared linked with higher risk for venous thromboembolism among adults with metastatic lung cancer, according to study results presented at CHEST Annual Meeting.
In addition, adults who received immune checkpoint inhibitors (ICIs) that target PD-1 — such as cemiplimab (Libtayo, Regeneron), nivolumab (Opdivo, Bristol Myers Squibb) or pembrolizumab (Keytruda, Merck) — exhibited higher risk for pulmonary embolism than those who received ICIs that target PD-L1, such as atezolizumab (Tecentriq, Genentech) or durvalumab (Imfinzi, AstraZeneca).
The introduction of immunotherapy has improved survival for patients with metastatic lung cancer. Prior research demonstrated improved 1-year, 3-year and 5-year OS for those treated during the immunotherapy era than those treated prior to immunotherapy availability in the United States.
However, data are limited about the risk for thromboembolic events among patients with metastatic lung cancer who receive ICIs.
Researchers reviewed the TriNetX Research Network database to identify adults diagnosed with metastatic lung cancer between September 2014 and September 2023 who received either a PD-1 or PD-L1 ICI within 1 year of diagnosis.
Researchers evaluated 1-year incidence of venous and arterial thromboembolic events, including deep vein thrombosis, pulmonary embolism, myocardial infarction and cerebrovascular accident.
The analysis included data from 10,554 adults,, 1,630 of whom received at least one anti-PD-1 ICI with no additional ICI, and 434 of whom received at least one anti-PD-L1 ICI.
Prior to propensity-score matching, researchers noted all outcome events as being significantly more frequent among patients who received ICIs than those who did not. This trend persisted for DVT (20% vs. 13.1%; OR = 1.7; P < .001), PE (17.7% vs. 10.8%; OR = 1.8; P < .001), myocardial infarction (11.6% vs. 6.5%; OR = 1.9; P < .001) and cerebrovascular accident (10.9% vs. 8.3%; OR = 1.3; P < .001).
In propensity-matched cohorts, researchers observed higher incidence of thromboembolic events among ICI recipients compared with nonrecipients. The difference reached statistical significance for PE (17% vs. 14.6%; OR = 1.2; 95% CI, 1.1-1.4) and myocardial infarction (11.1% vs. 9.3%; P = 0.58) but did not reach statistical significance for DVT (19.3% vs. 17.9%).
Cerebrovascular accident occurred less frequently among ICI users than nonusers (10.4% vs. 12.7%; OR = 0.8; 95% CI, 0.7-0.9).
“Clinicians caring for patients with metastatic lung cancer treated with ICIs should be wary of signs and symptoms of thromboembolism, as these patients are at an even higher risk of TEE than the baseline risk excess of metastatic cancer,” researchers wrote.
References:
- Fowler C, et al. Chest. 2024;doi:10.1016/j.chest.2024.06.2589.
- Fowler C, et al. Thromboembolic risk among immune checkpoint inhibitor recipients with metastatic lung cancer. Presented at: CHEST Annual Meeting; Oct. 6-9, 2024; Boston.
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Fowler C, et al. Thromboembolic risk among immune checkpoint inhibitor recipients with metastatic lung cancer. Presented at: CHEST Annual Meeting; Oct. 6-9, 2024; Boston.
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