Oxaliplatin-based chemotherapy regimens were associated with a significantly lower incidence of thromboembolic events compared to cisplatin-based regimens (7.6% vs 15.1%; P=0.0003).
RCT (n=964)
Yes
Does oxaliplatin-based chemotherapy reduce thromboembolic events compared to cisplatin-based chemotherapy in patients with advanced gastroesophageal cancer?
Oxaliplatin-based chemotherapy is associated with a significantly lower risk of thromboembolic events compared to cisplatin-based regimens in patients with advanced gastroesophageal cancer.
Effect estimate: HR 0.51 (95% CI 0.34-0.76)
Absolute Event Rate: 7.6% vs 15.1%
p-value: p=0.001
PURPOSE: Data concerning the prevalence of and outcomes related to thromboembolic events (TEs) in patients with advanced gastroesophageal cancer who are undergoing chemotherapy are limited. PATIENTS AND METHODS: This was a prospective, exploratory analysis of TEs in a randomized, controlled trial of 964 patients recruited between 2000 and 2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy for advanced/locally advanced gastroesophageal cancer. Regimens were epirubicin (E), cisplatin (C), fluorouracil (F; ECF); E, C, capecitabine (X; ECX); E, F, oxaliplatin (O; EOF); and EOX. Continuously infused F was administered via a central venous access device (CVAD) with 1 mg of warfarin for thromboprophylaxis. The principal outcome was the incidence of TEs (venous and arterial) in the whole treated patient cohort, according to chemotherapy, associated with CVADs and TE-related prognoses. RESULTS: The incidences of any, of venous, and of arterial TEs among 964 treated patients were 12.1% (95% CI, 10.7 to 14.3), 10.1% (95% CI, 8.3 to 12.3), and 2.2% (95% CI, 1.4 to 3.4) respectively. There were fewer TEs in the O compared with the cisplatin groups (EOF/EOX v ECF/ECX: 7.6% v 15.1%; P = .0003). C was identified as a risk factor for TE in multivariate analysis (hazard ratio HR, 0.51; 95% CI, 0.34 to 0.76; P = .001). There was no difference in the incidence of TEs for the F group compared with the capecitabine groups. The incidence of CVAD-related thrombosis was 7.0% (ECF/EOF arms). Overall survival was worse for patients who experienced TEs versus no TEs (median survival, 7.4 v 10.5 months; HR, 0.8; 95% CI, 0.64 to 0.99; P = .043). CONCLUSION: This analysis has prospectively quantified the incidence/pattern of TEs among patients with advanced gastroesophageal cancer who were treated with four triplet regimens, has demonstrated a differential thrombogenic effect according to platinum use, and has noted a poorer outcome associated with TE during treatment. Chemotherapy-related TE should contribute to the risk/benefit assessment of treatment.
Starling et al. (Tue,) conducted a rct in advanced gastroesophageal cancer (n=964). Oxaliplatin-based chemotherapy (EOF/EOX) vs. Cisplatin-based chemotherapy (ECF/ECX) was evaluated on Incidence of thromboembolic events (venous and arterial) (HR 0.51, 95% CI 0.34-0.76, p=0.001). Oxaliplatin-based chemotherapy regimens were associated with a significantly lower incidence of thromboembolic events compared to cisplatin-based regimens (7.6% vs 15.1%; P=0.0003).
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