Medizinische Universität Graz - Research portal
Selected Publication:
Berton, F.
Venous thromboembolism in patients with cancer treated with immune checkpoint inhibitors
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2024. pp. 58
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- Authors Med Uni Graz:
- Advisor:
- Moik Florian
- Riedl Jakob
- Altmetrics:
- Abstract:
- Background: Patients with cancer treated with ICI are at substantial VTE-risk, yet clinical risk profiles are currently unclear. Our aim was to determine the incidence, clinical consequences, and risk factors for VTE during ICI-therapy to support the development of future thromboprophylaxis strategies. Methods: Consecutive adult patients treated with ICI at the Medical University of Graz were included in this retrospective cohort study and followed for the occurrence of VTE during ICI-therapy. Statistical analyses were conducted in competing risk analysis, accounting for all-cause mortality as competing event. Risk of VTE according to time dependent exposure to ICI after cancer diagnosis was analysed in a multi-state model. Multivariable adjustment of models was conducted to account for potential confounders. Results: Overall, 417 patients were included [non-small cell lung cancer (41%), renal cell carcinoma (16%) and melanoma (15%)]. Over a median follow-up of 26.4 months, 37 VTE occurred [cumulative incidence: 12.2% (95% confidence interval [CI]: 8.7-16.4)]. VTE-risk was increased after ICI-initiation compared to the period from cancer-diagnosis to ICI-start (transition-hazard-ratio (HR): 3.30, 95%CI: 1.95-5.57). Similar incidences and no significant differences in risk were observed according to patient demographics, comorbidity burden, cancer-type and -stage. The Khorana-score did not predict VTE-risk (subdistribution-HR [score ≥2]: 0.88, 95%CI: 0.45-1.72). Baseline levels of routine laboratory parameters including C-reactive protein (CRP) did not predict VTE-risk, yet early increases in CRP (2-fold increase within 3 months of ICI-initiation) were associated with a significantly higher VTE-risk (adjusted subdistribution-HR: 2.31, 95%CI: 1.06-5.02), with a cumulative incidence of 22.9% in patients with an early CRP-rise. Conclusion: A substantial burden of VTE among ICI-treated patients was observed, characterised by homogenously high risks irrespective of underlying patient- and cancer-characteristics. Longitudinal trajectories of inflammatory biomarkers might identify patients at very high VTE risk.