Risk of Venous Thromboembolism in Patients Receiving Targeted Anti-cancer Therapy - A Nationwide Cohort Study

Saturday, August 27, 2022

1:00 PM – 1:15 PM CEST

Location: Congress Hall D2

Publication Number: 157

Background: Evidence show high rates of venous thromboembolism (VTE) associated with targeted anti-cancer therapies.

Objectives: To examine absolute and relative risks of VTE in patients treated with immune-checkpoint-inhibitors (ICIs), multi-kinase-inhibitors (MKIs), VEGF-, HER-2-, EGFR-, and ALK-/ROS-targeted therapies.

Methods: Using Danish medical databases, we conducted a nationwide cohort study of cancer patients treated with a preselected agent between 2004 and 2018. Cancer patients were followed from therapy initiation date until VTE diagnosis, death, emigration, one year of follow-up, or December 31, 2018, whichever came first. Cumulative incidence of VTE was computed using competing-risk analysis. Relative risk of VTE was evaluated in a matched case-control design, assessing exposure to targeted treatments within 3 months before VTE. VTE-free controls were matched (4:1) on age, sex, calendar year, and year of cancer diagnosis. Odds ratios (ORs) as a measure of relative risk and associated 95% confidence intervals (CIs) were controlled for matching variables by study design and adjusted for cancer stage at diagnosis, comorbidities, and time from cancer diagnosis to index date using conditional logistic regression.

Results: 31,224 cancer patients were included in the cohort analysis. Cumulative 1-year risks of VTE were highest for anti-EGFR (6.3%, 95%CI: 5.8-6.9), anti-VEGF (6.0%, 95%CI: 5.6-6.5), and ICI therapies (5.7%, 95%CI: 4.9-6.6). 11,434 VTE cases and 45,492 VTE-free controls were included in the case-control analysis. Colorectal cancer patients had an elevated VTE risk after recent anti-VEGF therapy (OR: 2.49, 95%CI: 2.09—2.97) or anti-EGFR treatment (OR: 3.33, 95%CI: 2.64—4.21). In lung cancer, risk of VTE was higher with recent ICIs (OR: 1.45, 95%CI: 1.01—2.07) and anti-EGFR (OR: 2.12, 95%CI: 1.65—2.73). Recent ICIs therapy was associated with increased VTE risk in patients with melanoma (OR: 6.48, 95%CI: 3.07—13.65) and urogenital cancer (OR: 1.75, 95%CI: 0.69—4.45).

Conclusions: In this nationwide analysis, we provided large-scale comprehensive data on targeted anti-cancer therapies and VTE risk. The substantial absolute thrombotic risk and relative increase compared to controls for certain agents allow identification of high-risk populations for VTE among cancer patients.

Presenting Author(s)

Erzsebet Horvath-Puho

Aarhus N, Midtjylland, Denmark

Co-Author(s)

FM

Florian Moik

Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria, Austria
CA

Cihan Ay

Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria, Austria
JH

John-Bjarne Hansen

Thrombosis Research Center, Department of clinical medicine, UiT – The Arctic university of Norway and University Hospital of North Norway, Tromsø, Norway, Norway
FM

Frits Mulder

Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Netherlands
Nv

Nick van Es

Department of Vascular Medicine, Amsterdam Cardiovascular Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands, Netherlands
HS

Henrik Toft Sørensen, MD, PhD, DMSc, DSc

Professor & Chair
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark, Midtjylland, Denmark