1552P - Patterns of venous and arterial thromboembolism in patients with advanced pancreatic cancer treated with palliative first line chemotherapy of gemcitabine/nab-paclitxel or FOLFIRINOX

Background

This multicenter retrospective cohort study aims to investigate incidence, risk factors and disease outcomes of VTE (venous thromboembolism) and ATE (arterial thromboembolism) in patients with advanced pancreatic cancer (aPC).

Methods

We retrospectively enrolled 455 aPC patients treated with palliative 1^st-line chemotherapy (gemcitabine/nab-Paclitaxel (GN) or mFOLIRINOX) at three academic centers in Austria (Graz, Salzburg, Innsbruck). The primary outcome was a composite of symptomatic or incidental VTE (deep vein thrombosis and/or pulmonary embolism) and/or ATE (myocardial infarction, stroke, or systemic arterial embolism).

Results

Over a median follow up of 9.6 months [IQR: 4.6-16] we observed 85 VTE [cumulative risk: 20.0%] and 11 ATE events [cumulative risk: 2.8%]. Occurrence of VTE was associated with an immediate increase in the risk of death (transition hazard ratio (THR) for VTE occurrence: 1.59 [95% confidence interval (CI): 1.21-2.09]), while the impact of ATE on mortality was numerical but not statistically significant (THR: 1.85 [95%CI: 0.87-3.94]). Risk of disease progression during 1^st line chemotherapy was increased in patients after the occurrence of VTE (1.49 [95%CI: 1.09-2.03]). The strongest predictors for VTE and ATE were history of VTE [sub-distribution HR (sHR) 2.70 [95%CI: 1.75-4.18]) and history of stroke or transient ischemic attack [sHR: 31.15 [95%CI: 9.08-106.89) p<0.001], respectively. Risk of VTE and ATE did not significantly differ according to type of 1^st line chemotherapy (SHR for mFOLFIRINOX vs GN: VTE: 1.16 [95%CI: 0.75-1.79]; ATE: 0.18 [95%CI 0.02-1.41]). Three validated prediction models for cancer-associated VTE (Khorana-, CONKO, and PROTECHT-score) failed to identify patients at high risk of VTE.

Conclusions

VTE and ATE are frequent complications in patients with aPC. The occurrence of VTE has a negative impact on the clinical course of disease, with an association with increased mortality and risk of disease progression. Clinical risk factors were mostly found to be ineffective for prediction of VTE/ATE in this patient cohort.

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.