Venous thromboembolism risk in cancer patients receiving first-line immune checkpoint inhibitor versus chemotherapy.
Venous thromboembolism risk in cancer patients receiving first-line immune checkpoint inhibitor versus chemotherapy.
复制标题
接受一线免疫检查点抑制剂与化疗的癌症患者的静脉血栓栓塞风险。
DOI：
10.1002/ajh.26954
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发表时间：
2023
影响因子：
12.8
通讯作者：
Fillmore,NathanaelR
中科院分区：
文献类型：
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作者：
Li,Ang;May,SarahB;La,Jennifer;Martens,KyleeL;Amos,ChristopherI;Flowers,ChristopherR;Do,NhanV;Brophy,MaryT;Chitalia,Vipul;Ravid,Katya;Gaziano,JohnMichael;Fillmore,NathanaelR
目前尚不清楚免疫检查点抑制剂（ICI）治疗与细胞毒性化疗（化疗）相比，在具有可比癌症类型、分期和合并症的患者中，静脉血栓栓塞（VTE）的发生率是否更高。我们使用2016年至2021年国家退伍军人事务部医疗保健系统数据库，进行了一项倾向评分（PS）加权回顾性队列研究，比较接受一线ICI与化疗的选定III/IV期癌症患者的静脉血栓栓塞发生率。PS模型使用重叠权重来平衡年龄、性别、种族、治疗年、VTE病史、瘫痪/固定、住院时间延长、癌症类型、分期、诊断和治疗之间的时间以及国家癌症研究所合并症指数。使用具有稳健标准误的加权考克斯回归来评估风险比（HR）和95%置信区间（CI）。我们发现，在可比的晚期癌症中，一线ICI（n = 1823）和一线化疗（n = 6345）的VTE发生率相似（6个月时ICI为8.49%，化疗为8.36%）。ICI与化疗的加权HR为1.06（95% CI 0.88-1.26）。在仅限于肺癌的亚组分析中，一线ICI/化疗（n = 828）、ICI单药治疗（n = 428）和化疗单药治疗（n = 4371）的VTE发生率相似（6个月时ICI/化疗为9.60%，ICI为10.04%，化疗为8.91%）。ICI与化疗的加权HR为1.05（95% CI 0.77-1.42），ICI/化疗与化疗的加权HR为1.08（95% CI 0.83-1.42）。总之，ICI作为一种全身治疗，与细胞毒性化疗在癌症患者中发生VTE的风险相似。这一发现可以为未来探索血栓预防策略的前瞻性研究提供信息。
It remains unclear if immune checkpoint inhibitor (ICI) therapy is associated with higher rate of venous thromboembolism (VTE) compared with cytotoxic chemotherapy (chemo) in patients with comparable cancer type, staging, and comorbidities. Using the national Veterans Affairs healthcare system database from 2016 to 2021, we performed a propensity score (PS)‐weighted retrospective cohort study to compare the incidence of VTE in patients with selected stage III/IV cancer receiving first‐line ICI versus chemo. The PS model utilized overlap weights to balance age, sex, race, treatment year, VTE history, paralysis/immobilization, prolonged hospitalization, cancer type, staging, time between diagnosis and treatment, and National Cancer Institute comorbidity index. Weighted Cox regressions with robust standard error were used to assess the hazard ratio (HR) and 95% confidence interval (CI). We found that among comparable advanced cancers, first‐line ICI (n = 1823) and first‐line chemo (n = 6345) had similar rates of VTE (8.49% for ICI and 8.36% for chemo at 6 months). The weighted HR was 1.06 (95% CI 0.88–1.26) for ICI versus chemo. In a subgroup analysis restricted to lung cancers, first‐line ICI/chemo (n = 828), ICI monotherapy (n = 428), and chemo monotherapy (n = 4371) had similar rates of VTE (9.60% for ICI/chemo, 10.04% for ICI, and 8.91% for chemo at 6 months). The weighted HR was 1.05 (95% CI 0.77–1.42) for ICI versus chemo, and 1.08 (95% CI 0.83–1.42) for ICI/chemo versus chemo. In conclusion, ICI as a systemic therapy has a similarly elevated risk as cytotoxic chemo for VTE occurrence in cancer patients. This finding can inform future prospective studies exploring thromboprophylaxis strategies.