Risk factors for cancer-associated thrombosis in patients undergoing treatment with immune checkpoint inhibitors
Risk factors for cancer-associated thrombosis in patients undergoing treatment with immune checkpoint inhibitors
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DOI：
10.1007/s10637-019-00881-6
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发表时间：
2020-08-01
影响因子：
3.4
通讯作者：
Imaizumi, Kazuyoshi
中科院分区：
文献类型：
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作者：
Ando, Yosuke;Hayashi, Takahiro;Imaizumi, Kazuyoshi
目的已知抗癌药物会增加癌症相关血栓 (CAT) 的发生。据报道，基于顺铂的治疗中 CAT 发病率为 1.92%，紫杉醇加雷莫芦单抗联合治疗中的 CAT 发病率为 6.1%，贝伐珠单抗单药治疗中的 CAT 发病率为 11.9%。由于免疫检查点抑制剂 (ICIs) 会导致 T 细胞数量突然增加，因此这些药物的施用与 CAT 发病率增加之间可能存在关联。然而，ICI 给药对 CAT 发生率的影响程度仍不清楚。此外，CAT 发病的危险因素尚未确定。本研究调查了接受 ICI 的患者中 CAT 的发生率和相关危险因素。方法纳入 2017 年 4 月至 2018 年 3 月在藤田保健大学医院接受纳武单抗或派姆单抗治疗的患者。我们从电子病历中收集了有关年龄、性别、癌症类型、BMI、病史、治疗开始时的实验室数据、药物和计算机断层扫描 (CT) 解释的回顾性数据。结果我们从 135 名接受纳武单抗或派姆单抗治疗的患者中确定了 122 名符合条件的参与者。 10 名患者 (8.2%) 出现 CAT。静脉血栓栓塞（VTE）或动脉血栓栓塞（ATE）病史是CAT发生的危险因素（比值比：6.36，P = 0.039）。心脏病史可能是 CAT 发病的危险因素（比值比 6.56，P = 0.052）。发生 CAT 的患者 (60%) 的抗血小板和抗凝治疗使用率显着高于未发生 CAT 的患者 (13.4%，p < 0.01)。结论 ICI 给药期间 CAT 发生率较高 (8.2%)，表明与之前研究中调查的其他抗癌药物相比，ICI 与较低的血栓风险无关。对于有 VTE、ATE 或心脏病史的患者，即使接受抗血小板治疗，考虑 CAT 的可能性也至关重要。
PurposeAnticancer agents are known to increase cancer-associated thrombosis (CAT) onset. CAT onset rate is reported to be 1.92% in cisplatin-based therapy, 6.1% in paclitaxel plus ramucirumab combination therapy, and 11.9% in bevacizumab monotherapy. Because immune checkpoint inhibitors (ICIs) cause a sudden increase in T cell number, an association between administration of these drugs and increase in CAT incidence is likely. However, the extent to which ICI administration affects CAT incidence remains unclear. Further, risk factors for CAT incidence have not yet been identified. The present study investigated CAT incidence and associated risk factors in patients receiving ICI.MethodsPatients administered nivolumab or pembrolizumab at Fujita Health University Hospital from April 2017 to March 2018 were enrolled. We collected retrospective data regarding age, sex, cancer type, BMI, medical history, laboratory data at treatment initiation, medications, and computed tomography (CT) interpretations from electronic medical records.ResultsWe identified 122 eligible participants from 135 patients receiving nivolumab or pembrolizumab. Ten patients (8.2%) developed CAT. A history of venous thromboembolism (VTE) or arterial thromboembolism (ATE) was a risk factor for CAT incidence (odds ratio: 6.36,P = 0.039). A history of heart disease may be a risk factor for CAT incidence (odds ratio 6.56,P = 0.052). Significantly higher usage of antiplatelet and anticoagulant therapy was noted in patients who developed CAT (60%) than in those who did not (13.4%,p < 0.01).ConclusionHigh (8.2%) CAT incidence during ICI administration suggested that ICI is not associated with a lower blood clot risk than other anticancer agents investigated in previous studies. For patients with VTE, ATE, or heart disease history, it is crucial to consider the possibility of CAT even with antiplatelet therapy.