Key result
In patients with advanced pancreatic cancer on first-line chemotherapy, the cumulative incidence of VTE was 20.0% (95% CI 16.3-24.0), which was associated with increased mortality (THR 1.59).
Why the study?
Recent advances in prophylactic anticoagulation and antineoplastic treatment for advanced pancreatic cancer warranted an updated reassessment of thromboembolic risk in this population.
What is the incidence and prognostic impact of venous and arterial thromboembolism in patients with advanced pancreatic cancer undergoing first-line chemotherapy?
Cohort (n=455)
Yes
What is the incidence and prognostic impact of venous and arterial thromboembolism in patients with advanced pancreatic cancer undergoing first-line chemotherapy?
Patients with advanced pancreatic cancer on first-line chemotherapy have a high risk of VTE (20%), which is associated with increased mortality and cancer progression, and is poorly predicted by the Khorana score.
High VTE risk with mortality link in advanced pancreatic cancer on chemotherapy merits prophylaxis trials; leaves open survival benefit.
Introduction Recent advances in prophylactic anticoagulation and antineoplastic treatment for advanced pancreatic cancer (aPC) warrant an updated reassessment of thromboembolic risk in this population. This multicenter retrospective cohort study aims to comprehensively characterize incidence, risk factors, and outcomes of venous (VTE) and arterial thromboembolism (ATE) in homogenously treated patients with aPC. Methods Four hundred and fifty-five patients with aPC undergoing palliative first-line chemotherapy (Gemcitabine/nab-Paclitaxel (GN) or FOLIRINOX) were included. Primary outcomes were objectively confirmed VTE and/or ATE. Results Over a median follow-up of 26 months, 86 VTE (cumulative incidence: 20.0%; 95% confidence interval [CI]: 16.3–24.0) and 11 ATE events (cumulative incidence: 2.8%; 95% CI: 1.5–4.9) were observed. VTE diagnosis was associated with increased mortality (transition hazard ratio [THR]: 1.59 [95% CI: 1.21–2.09]) and increased risk of cancer progression (THR: 1.47 [95% CI: 1.08–2.01]), while the impact of ATE on mortality was numerically but not statistically significant (THR: 1.85 [95% CI: 0.87–3.94]). The strongest predictor of increased VTE risk was history of cancer-associated VTE (subdistribution hazard ratio [SHR]: 3.29 [95% CI: 2.09–5.18]), while the Khorana score (SHR: 0.78 [0.57–1.06]) failed to predict VTE risk. A history of cerebrovascular disease was associated with markedly increased ATE risk (SHR: 22.05 [95% CI: 6.83–71.22], p < 0.001), especially ischemic stroke. Risk of VTE/ATE did not significantly differ according to type of first-line chemotherapy. Conclusion Patients with aPC undergoing palliative first-line chemotherapy with FOLFIRINOX or GN face a high risk for VTE/ATE and its diagnosis is linked to worse clinical outcomes. VTE-risk prediction models have limited ability to sub-stratify thrombotic events in this high-risk scenario.
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Riedl et al. (2021) conducted a cohort in advanced pancreatic cancer (n=455). Palliative first-line chemotherapy (FOLFIRINOX or Gemcitabine/nab-Paclitaxel) was evaluated on objectively confirmed VTE (95% CI 16.3-24.0). In patients with advanced pancreatic cancer on first-line chemotherapy, the cumulative incidence of VTE was 20.0% (95% CI 16.3-24.0), which was associated with increased mortality (THR 1.59).
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