Patients with cancer and COVID-19 may need close monitoring and personalized thromboprophylaxis due to an increased risk of venous thromboembolism (VTE), according to researchers.
The researchers found a higher risk of VTE in patients with cancer and COVID-19 who were receiving systemic cancer therapies. Underlying risk factors and demographic factors were also associated with the risk of VTE.
These findings were published in JAMA Oncology.
The study (ClinicalTrials.gov Identifier: NCT04354701) included 4988 patients with cancer and COVID-19 who were hospitalized. A total of 2179 patients (44%) had active cancer, and 1541 (31%) had metastatic cancer.
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Most patients (n=3119; 62%) had not received systemic therapy in the 3 months prior to SARS-CoV-2 infection. Of the patients who had received recent systemic treatment, 466 (9%) received endocrine therapy, 332 (7%) received VEGF inhibitors (VEGFis) or tyrosine kinase inhibitors (TKIs), 138 (3%) received immunomodulatory drugs (IMiDs), 262 (5%) received immune checkpoint inhibitors (ICIs), and 1002 (20%) received chemotherapy.
In the overall cohort, the incidence of any thromboembolic event (TEE) was 11%, the incidence of VTE was 7%, and the incidence of arterial thromboembolism (ATE) was 4%.
The incidence of ATE in patients with recent systemic therapy was the same or lower than the incidence in patients who were not recently exposed to systemic therapy. In a log-binomial regression model, the relative risk of ATE was not significantly different between the groups (adjusted risk ratio [aRR], 0.81; 95% CI, 0.56-1.16).
However, the incidence of VTE was higher among patients recently exposed to systemic therapy than among unexposed patients. The incidence of VTE was 6% in the unexposed patients, 7% in those who received endocrine therapy, 8% in IMiD recipients, 10% in VEGFi/TKI recipients, 10% in chemotherapy recipients, and 12% in ICI recipients.
In a log-binomial regression model, recent exposure to systemic therapy was associated with a significantly higher risk of VTE (aRR, 1.33; 95% CI, 1.04-1.69). When the researchers assessed the treatments individually, the association was only significant for ICIs (aRR, 1.45; 95%CI, 1.01-2.07).
Other factors associated with a significantly higher risk of VTE were active or progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), a history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and cancers with a high risk of VTE per Khorana score (aRR, 1.42; 95% CI, 1.14-1.75).
There was no significant association between systemic treatment and the risk of TEEs overall, but the risk of TEEs was associated with other factors. Black patients had a significantly higher risk of TEEs than White patients (aRR, 1.24; 95% CI, 1.03-1.50).
Patients with a history of VTE also had a higher risk of TEEs (aRR, 2.33; 95% CI, 1.88-2.89), as did patients who had cancers with a high risk of VTE (aRR, 1.20; 95% CI, 1.02-1.42).
Among patients who had TEEs, 25% died within 30 days, 46% were admitted to the intensive care unit, and 31% required mechanical ventilation.
“[P]atients with cancer and COVID-19 who require hospitalization and have recently received TOIs [treatments of interest] are at a relatively high risk of VTEs; those patients who experience a TEE are at very high risk of death,” the researchers summarized.
“Although not designed to prove causality between systemic therapy exposure and TEEs, our study highlights a potential association, and further investigation with prospective studies and randomized clinical trials is recommended to address risk-mitigation strategies,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Gulati S, Hsu C-Y, Shah S, et al. Systemic anticancer therapy and thromboembolic outcomes in hospitalized patients with cancer and COVID-19. JAMA Oncol. Published August 17, 2023. doi:10.1001/jamaoncol.2023.2934
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