Profile of metastatic lung cancer patients susceptible to development of thromboembolism during immunotherapy

Satoshi Endo; Takayuki Honda; Tatsuo Kawahara; Rie Sakakibara; Takahiro Mitsumura; Tsukasa Okamoto; Yasunari Miyazaki

doi:10.1016/j.ctarc.2022.100547

Profile of metastatic lung cancer patients susceptible to development of thromboembolism during immunotherapy

Cancer Treat Res Commun. 2022:31:100547. doi: 10.1016/j.ctarc.2022.100547. Epub 2022 Mar 10.

Authors

Satoshi Endo¹, Takayuki Honda¹, Tatsuo Kawahara², Rie Sakakibara¹, Takahiro Mitsumura¹, Tsukasa Okamoto³, Yasunari Miyazaki⁴

Affiliations

¹ Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
² Division of Respiratory Medicine, Shuwa General Hospital, 1200 Yahara-Shinden, Kasukabe, Saitama 344-0035, Japan.
³ Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Department of Pulmonary Immunotherapeutics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
⁴ Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan. Electronic address: miyazaki.pilm@tmd.ac.jp.

PMID: 35290865
DOI: 10.1016/j.ctarc.2022.100547

Abstract

Background: Thromboembolism (TE) is a serious complication in lung cancer patients; however, risk factors for developing TE during treatment with immuno-oncology (IO) drugs are unclear.

Materials and methods: A retrospective study of lung cancer patients hospitalized in Tokyo Medical and Dental University was performed to clarify the association between TE and systemic therapy, especially IOs. Patients were divided into an IO cohort, a chemotherapy cohort (CT cohort), and a control cohort (patients without recurrence after surgery). Association studies of variables relevant to TE were performed.

Results: A total of 592 patients were enrolled (IO cohort, 120; CT cohort, 294; control cohort, 178). Eight patients (6.7%) in the IO cohort, seven (2.4%) in the CT cohort, and three (1.7%) in the control cohort developed TE. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis identified IO, a history of TE, poor performance status (PS), and prior anticoagulation therapy as being associated with TE. Subsequent multivariate logistic regression analysis identified a history of TE (odds ratio (OR), 6.03; 95% confidence interval (CI), 2.09-17.40; P = 0.01) and poor PS (OR, 3.84; 95% CI, 1.34-11.00; P < 0.001) as potential risk factors for developing TE. The incidence of TE in the IO cohort patients with both of these characteristics was significantly higher (OR, 52.82; 95% CI, 6.72-506.37; P < 0.001) than that in the control cohort.

Conclusion: Lung cancer patients with a history of TE and poor PS are at increased risk of TE during treatment with IOs.

Micro abstract: The profiles of lung cancer patients susceptible to development of thromboembolism (TE) during immunotherapy are unclear, even though TE is associated with a worse prognosis. Here, association studies of variables relevant to TE revealed that patients with a history of TE and poor performance status are at higher risk of developing TE during immunotherapy.

Keywords: Chemotherapy; History of TE; Immuno-oncology drugs; PS; Thromboembolism.

MeSH terms

Cohort Studies
Humans
Immunotherapy / adverse effects
Lung Neoplasms* / complications
Lung Neoplasms* / drug therapy
Retrospective Studies
Thromboembolism* / epidemiology
Thromboembolism* / etiology