Thromboembolic risk in patients with lung cancer receiving systemic therapy
Summary In this retrospective study, we investigated the influence of chemotherapy and immunotherapy on thromboembolic risk among United States Veterans with lung cancer during their first 6 months (180 days) following initiation of systemic therapy. Included patients received treatment with common...
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| Veröffentlicht in: | British journal of haematology 2021-07, Vol.194 (1), p.179-190 |
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| creator | Madison, Cecelia J. Melson, Ryan A. Conlin, Michael J. Gundle, Kenneth R. Thompson, Reid F. Calverley, David C. |
| description | Summary
In this retrospective study, we investigated the influence of chemotherapy and immunotherapy on thromboembolic risk among United States Veterans with lung cancer during their first 6 months (180 days) following initiation of systemic therapy. Included patients received treatment with common front‐line agents that were divided into four groups: chemotherapy alone, immunotherapy alone, combination of chemo‐ and immunotherapies, and molecularly targeted therapies (control group). The cohort experienced a 7·4% overall incidence of thrombosis, but the analysis demonstrated significantly different rates among the different groups. We explored models incorporating multiple confounding variables as well as the competing risk of death, and these results indicated that both chemo‐ and immunotherapies were associated with an increased incidence of thrombosis, either alone or combined, compared with the control group (7·56%, P = 2.2 × 10–16; 10·2%, P = 2.2 × 10–16; and 7·87%, P = 2.4 × 10–14 respectively vs. 4·10%). The Khorana score was found to be associated with increased risk, as were vascular disease and metastases. We found an association between risk of thrombosis and the use of anticoagulation, accounting for several confounders, including history of thrombosis. Further study is warranted to better determine the drivers of thromboembolic risk and to identify ways to mitigate this risk for patients. |
| doi_str_mv | 10.1111/bjh.17476 |
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In this retrospective study, we investigated the influence of chemotherapy and immunotherapy on thromboembolic risk among United States Veterans with lung cancer during their first 6 months (180 days) following initiation of systemic therapy. Included patients received treatment with common front‐line agents that were divided into four groups: chemotherapy alone, immunotherapy alone, combination of chemo‐ and immunotherapies, and molecularly targeted therapies (control group). The cohort experienced a 7·4% overall incidence of thrombosis, but the analysis demonstrated significantly different rates among the different groups. We explored models incorporating multiple confounding variables as well as the competing risk of death, and these results indicated that both chemo‐ and immunotherapies were associated with an increased incidence of thrombosis, either alone or combined, compared with the control group (7·56%, P = 2.2 × 10–16; 10·2%, P = 2.2 × 10–16; and 7·87%, P = 2.4 × 10–14 respectively vs. 4·10%). The Khorana score was found to be associated with increased risk, as were vascular disease and metastases. We found an association between risk of thrombosis and the use of anticoagulation, accounting for several confounders, including history of thrombosis. Further study is warranted to better determine the drivers of thromboembolic risk and to identify ways to mitigate this risk for patients.</description><identifier>ISSN: 0007-1048</identifier><identifier>EISSN: 1365-2141</identifier><identifier>DOI: 10.1111/bjh.17476</identifier><identifier>PMID: 34137029</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; anticoagulation ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Chemotherapy ; Combined Modality Therapy ; Confounding Factors, Epidemiologic ; Female ; Hematology ; Humans ; Immunotherapy ; Immunotherapy - adverse effects ; Incidence ; Lung cancer ; Lung Neoplasms - blood ; Lung Neoplasms - complications ; Lung Neoplasms - drug therapy ; Lung Neoplasms - therapy ; Male ; Metastases ; Middle Aged ; Models, Biological ; Retrospective Studies ; Risk ; Thromboembolism ; Thromboembolism - epidemiology ; Thromboembolism - etiology ; Thromboembolism - prevention & control ; Thrombophilia - drug therapy ; Thrombophilia - etiology ; Thrombosis ; United States - epidemiology ; Vascular diseases ; Veterans ; Young Adult</subject><ispartof>British journal of haematology, 2021-07, Vol.194 (1), p.179-190</ispartof><rights>2021 British Society for Haematology and John Wiley & Sons Ltd</rights><rights>2021 British Society for Haematology and John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4436-2b41eb7e89233631fbe2089fd7f1af72cfa86468f6abbe4e677076efbc8f0a113</citedby><cites>FETCH-LOGICAL-c4436-2b41eb7e89233631fbe2089fd7f1af72cfa86468f6abbe4e677076efbc8f0a113</cites><orcidid>0000-0003-3661-5296 ; 0000-0002-0261-0414 ; 0000-0003-0451-0561</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fbjh.17476$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fbjh.17476$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34137029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Madison, Cecelia J.</creatorcontrib><creatorcontrib>Melson, Ryan A.</creatorcontrib><creatorcontrib>Conlin, Michael J.</creatorcontrib><creatorcontrib>Gundle, Kenneth R.</creatorcontrib><creatorcontrib>Thompson, Reid F.</creatorcontrib><creatorcontrib>Calverley, David C.</creatorcontrib><title>Thromboembolic risk in patients with lung cancer receiving systemic therapy</title><title>British journal of haematology</title><addtitle>Br J Haematol</addtitle><description>Summary
In this retrospective study, we investigated the influence of chemotherapy and immunotherapy on thromboembolic risk among United States Veterans with lung cancer during their first 6 months (180 days) following initiation of systemic therapy. Included patients received treatment with common front‐line agents that were divided into four groups: chemotherapy alone, immunotherapy alone, combination of chemo‐ and immunotherapies, and molecularly targeted therapies (control group). The cohort experienced a 7·4% overall incidence of thrombosis, but the analysis demonstrated significantly different rates among the different groups. We explored models incorporating multiple confounding variables as well as the competing risk of death, and these results indicated that both chemo‐ and immunotherapies were associated with an increased incidence of thrombosis, either alone or combined, compared with the control group (7·56%, P = 2.2 × 10–16; 10·2%, P = 2.2 × 10–16; and 7·87%, P = 2.4 × 10–14 respectively vs. 4·10%). The Khorana score was found to be associated with increased risk, as were vascular disease and metastases. We found an association between risk of thrombosis and the use of anticoagulation, accounting for several confounders, including history of thrombosis. Further study is warranted to better determine the drivers of thromboembolic risk and to identify ways to mitigate this risk for patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - therapeutic use</subject><subject>anticoagulation</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Chemotherapy</subject><subject>Combined Modality Therapy</subject><subject>Confounding Factors, Epidemiologic</subject><subject>Female</subject><subject>Hematology</subject><subject>Humans</subject><subject>Immunotherapy</subject><subject>Immunotherapy - adverse effects</subject><subject>Incidence</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - blood</subject><subject>Lung Neoplasms - complications</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - therapy</subject><subject>Male</subject><subject>Metastases</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Thromboembolism</subject><subject>Thromboembolism - epidemiology</subject><subject>Thromboembolism - etiology</subject><subject>Thromboembolism - prevention & control</subject><subject>Thrombophilia - drug therapy</subject><subject>Thrombophilia - etiology</subject><subject>Thrombosis</subject><subject>United States - epidemiology</subject><subject>Vascular diseases</subject><subject>Veterans</subject><subject>Young Adult</subject><issn>0007-1048</issn><issn>1365-2141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1vFSEUhonR2Gt14R8wk7jRxbQcYIDZmGij1trETV0ToIcO1_m4wkyb--_letummpSEkBwenrzkJeQ10CMo69ituyNQQsknZAVcNjUDAU_JilKqaqBCH5AXOa8pBU4beE4OuACuKGtX5PtFl6bBTVh2H32VYv5VxbHa2DniOOfqJs5d1S_jVeXt6DFVCT3G61gGeZtnHMqjucNkN9uX5FmwfcZXt-ch-fnl88XJaX3-4-u3k4_ntReCy5o5AegU6pZxLjkEh4zqNlyqADYo5oPVUkgdpHUOBUqlqJIYnNeBWgB-SD7svZvFDXjpS85ke7NJcbBpayYbzb83Y-zM1XRtNNNc6aYI3t0K0vR7wTybIWaPfW9HnJZsWCMYl0zCDn37H7qeljSW7-2oplWsBVqo93vKpynnhOE-DFCzq8iUiszfigr75mH6e_KukwIc74Gb2OP2cZP5dHa6V_4BKw-cHw</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Madison, Cecelia J.</creator><creator>Melson, Ryan A.</creator><creator>Conlin, Michael J.</creator><creator>Gundle, Kenneth R.</creator><creator>Thompson, Reid F.</creator><creator>Calverley, David C.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3661-5296</orcidid><orcidid>https://orcid.org/0000-0002-0261-0414</orcidid><orcidid>https://orcid.org/0000-0003-0451-0561</orcidid></search><sort><creationdate>202107</creationdate><title>Thromboembolic risk in patients with lung cancer receiving systemic therapy</title><author>Madison, Cecelia J. ; Melson, Ryan A. ; Conlin, Michael J. ; Gundle, Kenneth R. ; Thompson, Reid F. ; Calverley, David C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4436-2b41eb7e89233631fbe2089fd7f1af72cfa86468f6abbe4e677076efbc8f0a113</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - therapeutic use</topic><topic>anticoagulation</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Chemotherapy</topic><topic>Combined Modality Therapy</topic><topic>Confounding Factors, Epidemiologic</topic><topic>Female</topic><topic>Hematology</topic><topic>Humans</topic><topic>Immunotherapy</topic><topic>Immunotherapy - adverse effects</topic><topic>Incidence</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - blood</topic><topic>Lung Neoplasms - complications</topic><topic>Lung Neoplasms - drug therapy</topic><topic>Lung Neoplasms - therapy</topic><topic>Male</topic><topic>Metastases</topic><topic>Middle Aged</topic><topic>Models, Biological</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Thromboembolism</topic><topic>Thromboembolism - epidemiology</topic><topic>Thromboembolism - etiology</topic><topic>Thromboembolism - prevention & control</topic><topic>Thrombophilia - drug therapy</topic><topic>Thrombophilia - etiology</topic><topic>Thrombosis</topic><topic>United States - epidemiology</topic><topic>Vascular diseases</topic><topic>Veterans</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Madison, Cecelia J.</creatorcontrib><creatorcontrib>Melson, Ryan A.</creatorcontrib><creatorcontrib>Conlin, Michael J.</creatorcontrib><creatorcontrib>Gundle, Kenneth R.</creatorcontrib><creatorcontrib>Thompson, Reid F.</creatorcontrib><creatorcontrib>Calverley, David C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of haematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Madison, Cecelia J.</au><au>Melson, Ryan A.</au><au>Conlin, Michael J.</au><au>Gundle, Kenneth R.</au><au>Thompson, Reid F.</au><au>Calverley, David C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thromboembolic risk in patients with lung cancer receiving systemic therapy</atitle><jtitle>British journal of haematology</jtitle><addtitle>Br J Haematol</addtitle><date>2021-07</date><risdate>2021</risdate><volume>194</volume><issue>1</issue><spage>179</spage><epage>190</epage><pages>179-190</pages><issn>0007-1048</issn><eissn>1365-2141</eissn><abstract>Summary
In this retrospective study, we investigated the influence of chemotherapy and immunotherapy on thromboembolic risk among United States Veterans with lung cancer during their first 6 months (180 days) following initiation of systemic therapy. Included patients received treatment with common front‐line agents that were divided into four groups: chemotherapy alone, immunotherapy alone, combination of chemo‐ and immunotherapies, and molecularly targeted therapies (control group). The cohort experienced a 7·4% overall incidence of thrombosis, but the analysis demonstrated significantly different rates among the different groups. We explored models incorporating multiple confounding variables as well as the competing risk of death, and these results indicated that both chemo‐ and immunotherapies were associated with an increased incidence of thrombosis, either alone or combined, compared with the control group (7·56%, P = 2.2 × 10–16; 10·2%, P = 2.2 × 10–16; and 7·87%, P = 2.4 × 10–14 respectively vs. 4·10%). The Khorana score was found to be associated with increased risk, as were vascular disease and metastases. We found an association between risk of thrombosis and the use of anticoagulation, accounting for several confounders, including history of thrombosis. Further study is warranted to better determine the drivers of thromboembolic risk and to identify ways to mitigate this risk for patients.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>34137029</pmid><doi>10.1111/bjh.17476</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-3661-5296</orcidid><orcidid>https://orcid.org/0000-0002-0261-0414</orcidid><orcidid>https://orcid.org/0000-0003-0451-0561</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anticoagulants - therapeutic use anticoagulation Antineoplastic Combined Chemotherapy Protocols - adverse effects Antineoplastic Combined Chemotherapy Protocols - therapeutic use Chemotherapy Combined Modality Therapy Confounding Factors, Epidemiologic Female Hematology Humans Immunotherapy Immunotherapy - adverse effects Incidence Lung cancer Lung Neoplasms - blood Lung Neoplasms - complications Lung Neoplasms - drug therapy Lung Neoplasms - therapy Male Metastases Middle Aged Models, Biological Retrospective Studies Risk Thromboembolism Thromboembolism - epidemiology Thromboembolism - etiology Thromboembolism - prevention & control Thrombophilia - drug therapy Thrombophilia - etiology Thrombosis United States - epidemiology Vascular diseases Veterans Young Adult |
| title | Thromboembolic risk in patients with lung cancer receiving systemic therapy |
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