medwireNews: An analysis of the CCC19 registry has demonstrated a significant link between receipt of anticancer therapies within 3 months of a COVID-19 diagnosis and an elevated risk for venous thromboembolism (VTE).
By contrast, there was no such association for the development of arterial thromboembolism (ATE), but the risk for death following VTE or ATE was higher, albeit not statistically significantly, for patients with recent exposure to anticancer treatment, note the researchers in JAMA Oncology.
They say: “These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19–related thromboembolism in patients with cancer.”
From the CCC19 registry, the team identified 4988 hospitalized patients with cancer who had a laboratory-confirmed diagnosis of SARS-CoV-2 infection. Participants were aged a median of 69 years, 48% were women, 51% were White, 48% were current or former smokers, and 36% had a BMI of 30 kg/m2 or greater.
The 38% of patients who had received anticancer treatment in the 3 months prior to the COVID-19 diagnosis were categorized by type of therapy into groups that were not mutually exclusive – 20% received chemotherapy, 9% endocrine therapy, 7% VEGF inhibitors or tyrosine kinase inhibitors (TKIs), 5% immune checkpoint inhibitors (ICIs), and 3% received immunomodulators.
During the course of the study, VTEs occurred in 10% of the chemotherapy group, 7% of the endocrine therapy group, 10% of the VEGF inhibitor/TKI group, 12% of the ICI group, and 8% of the immunomodulator group.
These rates were “uniformly higher” than the 6% rate in the reference group that had not received recent anticancer treatment, note Shuchi Gulati (University of California Davis Comprehensive Cancer Center, Sacramento, USA) and colleagues.
Multivariable analysis showed that exposure to anticancer therapy was associated with a significantly higher risk for VTE, at an adjusted risk ratio (aRR) of 1.33, but the association appeared to be primarily driven by an increased risk with exposure to ICIs, at a significant aRR of 1.45.
“Although other [treatments of interest] were associated with higher risk of VTE, these associations were not significant,” say the investigators.
Recent anticancer treatment did not appear to increase the risk for ATEs, with rates either the same or lower than that in the reference group (2–5% vs 5%) and there were no significant associations in multivariable analysis.
Among individuals who developed a thromboembolic event, the mortality rate was higher among those with than without recent exposure to systemic therapies, at 46% versus 38%, but the aRR of 1.12 did not reach statistical significance.
Gulati et al also identified other factors significantly associated with an elevated risk for VTEs, such as history of VTE, active or progressing cancer, and high-risk site of cancer (aRRs=3.10, 1.43, and 1.42 respectively). Factors associated with a significantly higher ATE risk were antiplatelet use and low-dose (<200 mg/day) aspirin use (aRRs=1.62 and 1.49, respectively).
Speaking to the novelty of the analysis, the study authors say that they “add systematic and detailed information on the association with specific anticancer therapies, which has not been presented before.”
And the team concludes: “Although not designed to prove causality between systemic therapy exposure and [thromboembolic events], our study highlights a potential association, and further investigation with prospective studies and randomized clinical trials is recommended to address risk-mitigation strategies.”
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