1424P - Outcome of thromboembolic events and its influence on survival time of advanced NSCLC patients receiving antiangiogenic therapy

Background

Antiangiogenetic therapy and lung cancer, per se, are associated with an increased risk of thromboembolic (TE) events. We aim to evaluate the influence of TE on the outcome of advanced non-small cell lung cancer (NSCLC) patients receiving antiangiogenic therapy.

Methods

This retrospective cohort study included advanced NSCLC patients receiving antiangiogenic therapy, including bevacizumab and ramucirumab, from March 2013 to May 2021 at Taichung Veterans General Hospital. All TE were confirmed by objective image studies. We evaluated the prevalence, pattern, treatment, and outcome of TE and its influence on survival time.

Results

A total of 427 patients were included. Of them, 345 (80.8%) received bevacizumab, 24 (5.6%) received ramucizumab, and 58 (13.6%) received both. The overall prevalence of TE was 10.1% (n = 43). Deep vein thrombosis (DVT) was the most common TE (n = 20), followed by pulmonary embolism (PE) (n = 14), combined PE and DVT (n = 6), and cerebral vascular accidents (n = 3). Among them, 46.2% of DVT did not occur in the typical lower extremities. Two patients died of TE, which presented with massive middle cerebral artery territory infarction. Among patients with continuous use or reuse of antiangiogenetic therapy, 18.2% had recurrent TE events. At TE, 28 patients experienced progressive disease (TE with PD), while tumor status remained stable in another 15 patients (TE without PD). The post-TE survival of patients without and with PD was 8.9 months (95% CI 3.9-13.9) vs. 2.2 months (95% CI 0.1-4.3), P = 0.012. As compared with patients without TE (31.4 months [95% CI 27.1-35.7]), TE with PD patients experienced a significantly shorter overall survival (20.1 months [95% CI 15.5-24.6]), but TE without PD patients had comparable survival time (32.7 months [95% CI 7.4-28.1]) (P = 0006). Multivariate analysis suggested that the use of hormone analog and proteinuria independently predicted a higher TE prevalence among TE with PD patients (aOR 2.79 [95% CI 1.13=6.92]; P = 0.027) and TE without PD patients (aOR 4.30 [95% CI 1.13-16.42]; P = 0.033), respectively.

Conclusions

Owing to the different influences on the survival time and risk factors, TE with PD and TE without PD may be two different disease entities.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.