Abstract 1691P
Background
Lung cancer (LC) is associated with a high incidence of venous thromboembolism (VTE) and arterial thrombosis (AT). The impact of immune checkpoint inhibitors (ICI) on the risk of VTE/AT is unknown.
Methods
Retrospective and multicenter study (10 hospitals). LC patients who started ICI between 01/01/2015–31/12/2019 were recruited. A descriptive study and analysis of overall survival (OS) was performed using the Kaplan-Meier method.
Results
665 patients were recruited, with a median age of 64 years, 69.8% being men, 5.1% had a history of VTE/AT prior to cancer diagnosis. 63.6% of overall patients had stage IV and 29.5% had stage III. The most frequent histologies were adenocarcinoma (58%) and squamous cell carcinoma (31.4%). PD-L1 was determined in 79.7%, with an expression level >50% in 59.8% and <1% in 19.1%. 92.9% had ECOG 0-1. The ICIs were mainly used in first (48.1%) and second (35.3%) line. The most used regimens were pembrolizumab (45.95%), nivolumab (17.9%) and atezolizumab (10.8%). Between the diagnosis of cancer and the beginning of ICI, 7.2% presented VTE/AT. The incidence of VTE/AT associated with ICI in the study period was 8.7%. Within this subgroup, 82.75% had stage IV, with a worse functional status (60.34% ECOG 0-1 and 32.76% ECOG 2). In the reassessed patients (75.86%), 52.27% had disease progression. At the diagnosis of VTE/AT, 13.8% and 12.06% received prophylactic/therapeutic anticoagulation. The most frequent type of VTE was pulmonary embolism (48.27%), with 5.8% acute myocardial infarction and 8.6% stroke as events of AT. 46.55% of the events occurred during the first 3 months after the start of ICI and 63.8% were symptomatic. 51.72% were admitted to the hospital. 77.58% received low molecular weight heparin. After starting anticoagulation, 8.6% had re-thrombosis and 12.1% had hemorrhages. In multivariate analysis, hemoglobin <10.9 mg/dl, neutrophil/lymphocyte ratio <4.55, and thrombosis between cancer diagnosis and start of immunotherapy were associated with an increased risk of VTE/AT. Median OS in the group with thrombosis was 12 months (95% CI 4,84 -19,16) versus 19 months (95% CI 16,11- 21.90) in the group without thrombosis (p = 0,0049).
Conclusions
The incidence of VTE/AT in patients with ICI was 8.7%, with a statistically significant impact on OS.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
D. Fernandez Garay: Financial Interests, Personal, Invited Speaker: Leo Pharma; Financial Interests, Personal, Invited Speaker: Angelini Pharma; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Invited Speaker: KyowaKirin. L. Ortega Morán: Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Leo Pharma; Financial Interests, Personal, Invited Speaker: Amngen; Financial Interests, Personal, Invited Speaker: Merck. J. Brenes Castro: Financial Interests, Personal, Invited Speaker: Merck; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: Takeda; Financial Interests, Personal, Invited Speaker: MSD. M. Lobo de Mena: Financial Interests, Personal, Advisory Board: Fresenius; Financial Interests, Personal, Invited Speaker: Leo Pharma; Financial Interests, Personal, Invited Speaker: Pfizer; Financial Interests, Personal, Invited Speaker: Servier; Financial Interests, Personal, Invited Speaker: Vifor Pharma. B. Obispo Portero: Financial Interests, Personal, Invited Speaker: Lilly; Financial Interests, Personal, Invited Speaker: Novartis; Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Fresenius; Financial Interests, Personal, Invited Speaker: Angelini; Financial Interests, Personal, Invited Speaker: Rovi; Financial Interests, Personal, Invited Speaker: Leo Pharma. A. Muñoz Martín: Financial Interests, Personal, Invited Speaker: Sanofi; Financial Interests, Personal, Invited Speaker: Leo Pharma; Financial Interests, Personal, Invited Speaker: BMS, Pfizer; Financial Interests, Personal, Invited Speaker: Rovi; Financial Interests, Personal, Invited Speaker: Bayer; Financial Interests, Personal, Invited Speaker: Daiichi-Sanko; Financial Interests, Institutional, Invited Speaker: Leo Pharma; Financial Interests, Institutional, Invited Speaker: Rovi. M. Sánchez Cánovas: Financial Interests, Personal, Invited Speaker: Leo Pharma; Financial Interests, Personal, Invited Speaker: Angelini Pharma; Financial Interests, Personal, Invited Speaker: Kyowakirin. All other authors have declared no conflicts of interest.