ABSTRACT

PURPOSE: Hypercoagulable state is a complication of various infections, and inflammatory processes and is a common scenario in cancer patients also. Timely diagnosis and treatment are essential to reduce further complications in such patients. The present study aimed to assess the role of FDG PET/CT in the diagnosis of benign vs. malignant tumor thrombus and to determine cut-off SUVmax to differentiate them.

PATIENTS AND METHODS: We retrospectively reviewed all FDG PET/CT scans of patients done in our department from January 2017 to March 2022. All scans were reviewed by two experienced nuclear medicine physicians. A total of 135 patients who had venous or arterial thrombus in FDG PET/CT scans were included. All the FDG PET/CT scans of 135 patients were analyzed for primary tumor site and/or site of thrombus. Additional clinical data were collected for patients with benign conditions in the form of ESR and CRP if available and doubtful cases were followed up by HPE reports and/or CEMRI. The SUV max of the primary tumor(in cancer patients), thrombus, and background (aorta) were calculated.

RESULTS: A total of 135 patients (108 cancer patients and 27 with benign thrombus) were included with an age range of 3 to 86 years (median 50 years). There were 91 males and 44 females. Of 108 cancer patients, the most common cancers were hepatocellular cancer - 38 (35.18%), renal cell cancer - 28(25.92%), and carcinoma of the thyroid - 6 (5.55%). Of 108 cancer patients, 36 (33.33%) had tumor thrombosis in inferior vena cava, 31 (28.70%) in the portal vein, and 41 (37.96%) in other vessels (renal vein, jugular vein, etc.). Of 27 patients with benign conditions,13 had venous thrombi, 11 had arterial thrombus and three had atrial thrombus and the most common thrombus sites were thoraco-abdominal aorta in seven (25.92%) and right atrium in three (11.11%) patients. In the subgroup of 108 oncological patients, the mean SUV max of the primary tumors was 17.67 (range 2.1-91.0; median 10.82), thrombi were 17.61 (range 2.14-90.11; median 14.56) and background was 5.29 (range 0.29-25.00; median 3.12). Of 27 patients with benign conditions, the mean SUV max of the thrombi was 11.09 (range 1.98-31; median 8.10) and the background was 9.80 (range 1.46-24.50; median 10.20) The ESR was raised in 13 of 26 patients (mean 35.84, range 10.98-62.00, median 35.00) and CRP was raised 22 of 26 patients (mean11.46, range 3.45-24.50, median 20.40). Upon plotting the receiver operating curve, a cutoff SUV max of 12.7 with a sensitivity of 62.96% and specificity of 77.77% was produced to demarcate tumor thrombus from benign thrombus.

CONCLUSION: FDG PET/CT plays a significant role in the detection of thrombo-embolic disease and can differentiate benign thrombus from tumor thrombus.

PMID:37272295 | DOI:10.1097/MNM.0000000000001708

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PubMed articles on: Cancer & VTE/PE

Risk for recurrence of symptomatic upper-extremity deep vein thrombosis in patients without cancer: Analysis of three RIETE cohorts

Vasc Med. 2023 Jun 5:1358863X231175185. doi: 10.1177/1358863X231175185. Online ahead of print.

ABSTRACT

BACKGROUND: The natural history of patients with a pacemaker-related upper-extremity deep vein thrombosis (UEDVT) has not been consistently studied.

METHODS: We used the RIETE registry data to compare the outcomes during anticoagulation and after its discontinuation in noncancer patients with symptomatic UEDVT associated with a pacemaker, other catheters, or no catheter. The major outcome was the composite of symptomatic pulmonary embolism or recurrent DVT.

RESULTS: As of February 2022, 2578 patients with UEDVT were included: 156 had a pacemaker-related UEDVT, 557 had other catheters, and 1865 had no catheter. During anticoagulation, 61 patients (2.3%) developed recurrent VTE, 38 had major bleeding (1.4%), and 90 died (3.4%). After its discontinuation, 52 patients (4.4%) had recurrent acute venous thromboembolism (VTE) and six had major bleeding (0.5%). On multivariable analysis, there were no differences among subgroups in the rates of VTE recurrences or major bleeding during anticoagulation. After its discontinuation, patients with a pacemaker-related UEDVT had a higher risk for VTE recurrences than those with no catheter (adjusted OR: 4.59; 95% CI: 1.98-10.6).

CONCLUSIONS: Patients with pacemaker-related UEDVT are at increased risk for VTE recurrences after discontinuing anticoagulation. If our findings are validated in adequately designed trials, this may justify changes in the current recommendations on the duration of anticoagulation.

PMID:37272085 | DOI:10.1177/1358863X231175185

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PubMed articles on: Cancer & VTE/PE

Correction to: Direct oral anticoagulants for venous thromboembolism in cancer patients: a systematic review and network meta-analysis

Support Care Cancer. 2023 Jun 3;31(6):373. doi: 10.1007/s00520-023-07851-y.

NO ABSTRACT

PMID:37269357 | DOI:10.1007/s00520-023-07851-y

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PubMed articles on: Cancer & VTE/PE

D-dimer testing: A narrative review

Adv Clin Chem. 2023;114:151-223. doi: 10.1016/bs.acc.2023.02.006. Epub 2023 Mar 29.

ABSTRACT

D-dimer containing species are soluble fibrin degradation products derived from plasmin-mediated degradation of cross-linked fibrin, i.e., 'D-dimer'. D-dimer can hence be considered a biomarker of in vivo activation of both coagulation and fibrinolysis, the leading clinical application in daily practice of which is ruling out venous thromboembolism (VTE). D-dimer has been further evaluated for assessing the risk of VTE recurrence and helping define optimal duration of anticoagulation treatment in VTE, for diagnosing disseminated intravascular coagulation (DIC), and for screening those at enhanced risk of VTE. D-dimer assays should however be performed as intended by regulatory agencies, as their use outside these indications might make them a laboratory-developed test (LDT). This narrative review is aimed at: (1) reviewing the definition of D-dimer, (2) discussing preanalytical variables affecting D-dimer measurement, (3) reviewing and comparing the assays performance and some postanalytical variables (e.g., different units and age-adjusted cutoffs), and (4) discussing the interest of D-dimer measurement across different clinical settings, including pregnancy, cancer, and coronavirus disease 2019 (COVID-19).

PMID:37268332 | DOI:10.1016/bs.acc.2023.02.006

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PubMed articles on: Cancer & VTE/PE

Thrombotic Complications in Children with COVID-19 and MIS-C

J Thromb Haemost. 2023 May 31:S1538-7836(23)00434-8. doi: 10.1016/j.jtha.2023.05.020. Online ahead of print.

ABSTRACT

Coronavirus disease 2019 (COVID-19) associated coagulopathy is multifactorial and involves inflammation driven hypercoagulability, endothelial dysfunction, platelet activation and impaired fibrinolysis. Hospitalized adults with COVID-19 are at an increased risk of both venous thrombo-embolism (VTE) and ischemic stroke, resulting in adverse outcomes including mortality. While children with COVID-19 follow a less severe course, both arterial and venous thrombosis have been reported in hospitalized children with COVID-19. Additionally, some children develop a post-infectious, hyper-inflammatory illness termed Multisystem Inflammatory Syndrome of Childhood (MIS-C), which is also associated with hypercoagulability and thrombosis. Several randomized trials have evaluated the safety and efficacy of antithrombotic therapy in adults with COVID-19, though similar pediatric data are lacking. In this narrative review we discuss the postulated pathophysiology of COVID-19 coagulopathy, and summarize principal findings of the recently completed adult trials of antithrombotic therapy. We provide an up-to-date summary of pediatric studies investigating the rate of VTE and ischemic stroke in COVID-19 and MIS-C, in addition to reviewing the findings of the single, non-randomized pediatric trial investigating the safety of prophylactic anticoagulation. Lastly, we outline the adult and pediatric consensus guidelines on the use of antithrombotic therapy in this cohort. A detailed discussion of the practical implementation and current limitations of published data will hopefully address knowledge deficits surrounding the use of antithrombotic therapy in children with COVID-19, and generate hypotheses for future research.

PMID:37268064 | PMC:PMC10232718 | DOI:10.1016/j.jtha.2023.05.020

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PubMed articles on: Cancer & VTE/PE

Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin and Recurrent VTE in Patients With Cancer: A Randomized Clinical Trial

JAMA. 2023 Jun 2. doi: 10.1001/jama.2023.7843. Online ahead of print.

ABSTRACT

IMPORTANCE: In patients with cancer who have venous thromboembolism (VTE) events, long-term anticoagulation with low-molecular-weight heparin (LMWH) is recommended to prevent recurrent VTE. The effectiveness of a direct oral anticoagulant (DOAC) compared with LMWH for preventing recurrent VTE in patients with cancer is uncertain.

OBJECTIVE: To evaluate DOACs, compared with LMWH, for preventing recurrent VTE and for rates of bleeding in patients with cancer following an initial VTE event.

DESIGN, SETTING, AND PARTICIPANTS: Unblinded, comparative effectiveness, noninferiority randomized clinical trial conducted at 67 oncology practices in the US that enrolled 671 patients with cancer (any invasive solid tumor, lymphoma, multiple myeloma, or chronic lymphocytic leukemia) who had a new clinical or radiological diagnosis of VTE. Enrollment occurred from December 2016 to April 2020. Final follow-up was in November 2020.

INTERVENTION: Participants were randomized in a 1:1 ratio to either a DOAC (n = 335) or LMWH (n = 336) and were followed up for 6 months or until death. Physicians and patients selected any DOAC or any LMWH (or fondaparinux) and physicians selected drug doses.

MAIN OUTCOMES AND MEASURES: The primary outcome was the recurrent VTE rate at 6 months. Noninferiority of anticoagulation with a DOAC vs LMWH was defined by the upper limit of the 1-sided 95% CI for the difference of a DOAC relative to LMWH of less than 3% in the randomized cohort that received at least 1 dose of assigned treatment. The 6 prespecified secondary outcomes included major bleeding, which was assessed using a 2.5% noninferiority margin.

RESULTS: Between December 2016 and April 2020, 671 participants were randomized and 638 (95%) completed the trial (median age, 64 years; 353 women [55%]). Among those randomized to a DOAC, 330 received at least 1 dose. Among those randomized to LMWH, 308 received at least 1 dose. Rates of recurrent VTE were 6.1% in the DOAC group and 8.8% in the LMWH group (difference, -2.7%; 1-sided 95% CI, -100% to 0.7%) consistent with the prespecified noninferiority criterion. Of 6 prespecified secondary outcomes, none were statistically significant. Major bleeding occurred in 5.2% of participants in the DOAC group and 5.6% in the LMWH group (difference, -0.4%; 1-sided 95% CI, -100% to 2.5%) and did not meet the noninferiority criterion. Severe adverse events occurred in 33.8% of participants in the DOAC group and 35.1% in the LMWH group. The most common serious adverse events were anemia and death.

CONCLUSIONS AND RELEVANCE: Among adults with cancer and VTE, DOACs were noninferior to LMWH for preventing recurrent VTE over 6-month follow-up. These findings support use of a DOAC to prevent recurrent VTE in patients with cancer.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02744092.

PMID:37266947 | DOI:10.1001/jama.2023.7843

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PubMed articles on: Cancer & VTE/PE

Cerebral infarction related to nonbacterial thrombotic endocarditis in a middle-aged woman with uterine adenomyosis: A case report

Medicine (Baltimore). 2023 Jun 2;102(22):e33871. doi: 10.1097/MD.0000000000033871.

ABSTRACT

RATIONALE: Few isolated case reports and case series have reported arterial and venous thromboembolism related to adenomyosis; however, the underlying mechanism remains unclear.

PATIENT CONCERNS: A 47-year-old woman presented with dizziness, nausea, vomiting, and loss of consciousness after red blood cell transfusion. She was being treated for menorrhagia and severe anemia.

DIAGNOSES: Magnetic resonance imaging showed multiple infarctions in right cerebellum and bilateral frontal, parietal, and occipital lobes. Echocardiography performed during the evaluation for the source of emboli revealed multiple echogenic masses on the tricuspid aortic valve. There was no evidence of infection, and the masses on the aortic valve were diagnosed as nonbacterial thrombotic endocarditis. The levels of autoimmune antibodies and tumor markers except for carbohydrate antigen 19-9 and cancer antigen 125 were within the normal range. Uterine ultrasound showed a large adenomyosis. The patient was diagnosed with multiple cerebral and cerebellar infarctions due to nonbacterial thrombotic endocarditis, and hormone therapy and anticoagulation with warfarin were initiated.

INTERVENTIONS: The patient did not develop recurrent infarction during anticoagulant therapy; however, menorrhagia worsened requiring total hysterectomy.

OUTCOMES: The patient did not experience recurrent infarction despite the absence of anticoagulant therapy during the 3-year follow-up period.

LESSONS: The present case adds to the limited number of previously reported cases and supports that, albeit rare, adenomyosis can be associated with embolic infarction and suggests that nonbacterial thrombotic endocarditis might be the link between adenomyosis and embolic infarction.

PMID:37266639 | PMC:PMC10238019 | DOI:10.1097/MD.0000000000033871

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PubMed articles on: Cancer & VTE/PE

Body Mass Index (BMI) Related Morbidity with Thyroid Surgery

Laryngoscope. 2023 Jun 2. doi: 10.1002/lary.30789. Online ahead of print.

ABSTRACT

OBJECTIVES: The increase in incidence of thyroid cancer correlates with strict increases in body mass index (BMI) and obesity in the United States. Thyroid hormone dysregulation has been shown to precipitate circulatory volume, peripheral resistance, cardiac rhythm, and even cardiac muscle health. Theoretically, thyroid surgery could precipitate injury to the cardiopulmonary system.

METHODS: The American College of Surgery National Quality Improvement Program database was queried for thyroidectomy cases in the 2007-2020 Participant User files. Continuous and categorical associations between BMI and cardiopulmonary complications were investigated as reported in the database.

RESULTS: The query resulted 186,095 cases of thyroidectomy procedures in which the mean age was 51.3 years and sample was 79.3% female. No correlation was evident in univariate and multivariate analyses between BMI and the incidence of postoperative stroke or myocardial infarction. The incidence of complications was extremely low. However, risk of deep venous thrombosis correlated with BMI in the categorical, univariate, and multivariate (OR 1.036, CI 1.014-1.057, p < 0.01) regression analysis. Additionally, increased BMI was associated with increased risk of pulmonary embolism (PE) (OR 1.050 (1.030, 1.069), p < 0.01), re-intubation (OR 1.012 (1.002, 1.023), p = 0.02), and prolonged intubation (OR 1.031 (1.017, 1.045), p < 0.01).

CONCLUSION: Despite the rarity of cardiopulmonary complications during thyroid surgery, patients with very high BMI carry a significant risk of deep venous thrombosis, PE, and prolonged intubation.

LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2023.

PMID:37265205 | DOI:10.1002/lary.30789

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PubMed articles on: Cancer & VTE/PE

Prevention of venous thromboembolism in patients with cancer

BMJ. 2023 Jun 1;381:e072715. doi: 10.1136/bmj-2022-072715.

ABSTRACT

Venous thromboembolism (VTE) is a major cause of both morbidity and mortality in patients with cancer. Venous thromboembolism, which includes both deep vein thrombosis and pulmonary embolism, affects a sizable portion of patients with malignancy and can have potentially life threatening complications. Accurate assessment of risk as well as diagnosis and treatment of this process is paramount to preventing death in this high risk population. Various risk models predictive of venous thromboembolism in patients with cancer have been developed, and knowledge of these rubrics is essential for the treating oncologist. Subgroups of particular interest are inpatients receiving chemotherapy, postoperative patients after surgical debulking, and patients undergoing radiotherapy. Numerous newer drugs have become available for the prevention of venous thromboembolism in patients with cancer who are at high risk of developing the disease. These include the class of drugs called direct oral anticoagulants, (DOACs) which do not require the same monitoring that other modalities have previously required and are taken by mouth, preventing the discomfort associated with subcutaneous strategies. The appropriate risk stratification and intervention to prevent venous thromboembolism are vital to the treatment of patients with cancer.

PMID:37263632 | DOI:10.1136/bmj-2022-072715

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PubMed articles on: Cancer & VTE/PE

Accuracy of the Physicians' Intuitive Risk Estimation in the Diagnostic Management of Pulmonary Embolism: An Individual Patient Data Meta-Analysis

J Thromb Haemost. 2023 May 30:S1538-7836(23)00438-5. doi: 10.1016/j.jtha.2023.05.023. Online ahead of print.

ABSTRACT

BACKGROUND: In patients clinically suspected of pulmonary embolism (PE), physicians often rely on an intuitive estimation ('gestalt') of PE presence. Although shown to be predictive, gestalt is criticized for its assumed variation across physicians and lack of standardization.

OBJECTIVES: To assess the diagnostic accuracy of gestalt in diagnosing PE and gain insight into its possible variation.

METHODS: We performed an individual patient data meta-analysis including patients suspected of PE. The primary outcome was the diagnostic accuracy of gestalt for diagnosing PE, quantified as a risk ratio (RR) between gestalt and PE from a two-stage random-effect log-binomial meta-analysis regression as well as gestalts' sensitivity and specificity. Variability of these measures was explored across different healthcare settings, publication period, PE prevalence, patient subgroups (sex, heart failure, chronic lung disease, and items of the Wells score other than gestalt), and age.

RESULTS: We analysed 20,770 patients suspected of PE from 16 original studies. The prevalence of PE in patients with and without a positive gestalt was 28.8% versus 9.1%, respectively. The overall RR was 3.02 (95%CI 2.35, 3.87) and overall sensitivity and specificity were 74% (95%CI 68-79%) and 61% (95%CI 53-68%). Although variation was observed across individual studies (I2-90.63%), diagnostic accuracy was consistent across all subgroups and healthcare settings.

CONCLUSIONS: A positive gestalt was associated with a threefold increased risk of PE in suspected patients. Although variation was observed across studies, the RR of gestalt was similar across prespecified subgroups and healthcare settings, exemplifying its diagnostic value for all patients suspected of PE.

PMID:37263381 | DOI:10.1016/j.jtha.2023.05.023

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PubMed articles on: Cancer & VTE/PE

Current status and hotspots evolution in myeloproliferative neoplasm: a bibliometric analysis from 2001 to 2022

Eur Rev Med Pharmacol Sci. 2023 May;27(10):4510-4519. doi: 10.26355/eurrev_202305_32457.

ABSTRACT

OBJECTIVE: In the last 20 years, the field of myeloproliferative neoplasm (MPN) has changed dramatically. This study aims to provide new ideas for the scientific research of MPN by systematically combing the literature.

MATERIALS AND METHODS: CiteSpace and VOSviewer were used to carry out a bibliometric analysis of MPN papers to visualize the development process, research hotspots, and cutting-edge trends in clinical practice, mechanisms, and management strategies related to MPN.

RESULTS: 1,099 authors from 736 institutions in 113 countries/regions published 11,922 papers in 1,807 academic journals. The United States and Italy were in the leading positions in this research field. Mayo Clinic is the institution with the largest number of publications. Only a few countries and institutions have shown active cooperation. Ayalew Tefferi and Ruben A. Mesa are outstanding contributors to the field. Blood and Leukemia are considered influential journals based on publications and citations. In this field, the research of MPN mainly focuses on the occurrence and progress mechanism of MPN, the clinical significance of non-driving gene mutation, optimization of primary and secondary thromboprophylaxis, clinical research of long-acting interferon and JAK2 inhibitors, and exploration of better therapies for myelofibrosis (primary and secondary) and post-MPN acute myeloid leukemia (AML).

CONCLUSIONS: The research is in a stage of rapid development. The collaboration between different institutions or countries (regions) still has room to grow. The hotspot analysis shows that the research of MPN mainly focuses on gene mutation, thrombosis, new drug applications, disease progression, etc.

PMID:37259732 | DOI:10.26355/eurrev_202305_32457

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PubMed articles on: Cancer & VTE/PE

Thromboprophylaxis for COVID-19: Time to ask for an extension?

Vasc Med. 2023 Jun 1:1358863X231175183. doi: 10.1177/1358863X231175183. Online ahead of print.

NO ABSTRACT

PMID:37259519 | PMC:PMC10235914 | DOI:10.1177/1358863X231175183

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PubMed articles on: Cancer & VTE/PE

Thrombosis in the Neonatal Intensive Care Unit

Neoreviews. 2023 Jun 1;24(6):e356-e369. doi: 10.1542/neo.24-6-e356.

ABSTRACT

Neonates, particularly critically ill and premature infants, have one of the highest risks of thromboembolic complications, particularly venous thromboembolism (VTE), in the pediatric population. Recent data suggest that the incidence of VTE has significantly increased in neonates over the last few decades. Critically ill and premature infants exhibit multiple risk factors that place them at a high risk for thromboembolic events including developmental hemostasis, propensity to infections, and frequent need for central venous access. The clinical presentation, diagnostic modalities, and treatment strategies for thromboembolic complications in neonates vary based on several factors, including the etiology of the thromboembolic event, the anatomic site affected, and the patient's underlying comorbidities. Although guidelines for management are available, they are mostly based on consensus recommendations and on extrapolation from adult data due to a lack of high-quality data in the neonatal population. Current guidelines recommend anticoagulation for specific scenarios. More studies are necessary to elucidate optimal management strategies for newborns with thromboembolic complications.

PMID:37258498 | DOI:10.1542/neo.24-6-e356

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PubMed articles on: Cancer & VTE/PE

Disparities in the Outcomes of Acute Pulmonary Embolism in Hospitalized Patients with Hematologic Malignancy and Solid Tumor

Int Heart J. 2023;64(3):432-441. doi: 10.1536/ihj.22-704.

ABSTRACT

This study aimed to compare the clinical burden and healthcare utilization outcomes of hematologic versus solid malignancies in patients hospitalized with acute pulmonary embolism (PE). This population-based, retrospective study extracted and analyzed the discharge data from the 2016-2018 US National Inpatient Sample (NIS) of hospitalized patients with a primary diagnosis of acute PE and a subsequent diagnosis of hematologic malignancies or solid tumors. Prolonged length-of-stay (LOS) was defined as ≥75th percentile LOS of the study cohort. Unfavorable discharge was defined as discharged to nursing home or long-term facility. Univariate and multivariate regression analyses were conducted to determine associations between cancer type, presence of unstable PE, and in-hospital outcomes in acute PE patients. Patients with acute PE with solid tumors had higher rates of in-hospital deaths and unfavorable discharge than those with hematologic malignancies (6.4% versus 3.2%, P < 0.001; 14.0% versus 11.2%, P = 0.01, respectively). Acute PE patients with hematologic malignancies had a lower risk of in-hospital death (aOR: 0.43, 95% CI: 0.31-0.60), unfavorable discharge (aOR: 0.76, 95% CI: 0.63-0.92), and prolonged LOS (aOR: 0.83, 95% CI: 0.71-0.98) than those with solid tumors. Stratified analysis showed that male patients aged <60

PMID:37258119 | DOI:10.1536/ihj.22-704

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PubMed articles on: Cancer & VTE/PE

Risk Factors of Venous Thromboembolic Disease in Cancer Patients Treated with Immune Checkpoint Inhibitor

Thromb Haemost. 2023 May 31. doi: 10.1055/s-0043-1769609. Online ahead of print.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized the management of cancers. The risk factors and pathophysiological mechanisms of venous thromboembolic events (VTEs) of this new therapeutic class are still to be specified.

METHODS: The included patients had to have cancer and should be treated with ICI. Data analyzed included demographic data, biological data, and immune-related adverse events (IRAEs). We studied the prevalence of VTEs and the factors associated with VTEs.

RESULTS: Of 374 patients on ICI, over a median follow-up period of 15.2 months, the number of VTE was 50 (13.4%). The majority of patients were treated for metastatic melanoma or nonsmall cell lung cancer. There was no difference in prevalence or survival between cancer types. Patients with combined therapy composed of nivolumab and ipilimumab had higher 1-year cumulative VTE occurrence (29.3% [95% confidence interval [CI]: 9.7; 44.6]) than patients with pembrolizumab (14.9%, [95%CI: 2.5; 25.8], p= 0.03) or nivolumab (9.1%, [95% CI: 5.0; 12.9], p< 0.01). The presence of IRAE was associated with a higher risk of VTE occurrence compared with patients without any IRAE (1-year VTE cumulative incidence: 17.42% [95% CI: 9.5; 24.65] vs. 9.46% [95% CI: 5.18; 13.55], p= 0.04). There was a higher risk of VTE in patients treated with the combination of nivolumab and ipilimumab (adjusted subdistribution hazard ratio [SHR]: 3.71 [95% CI: 1.74; 7.90], p< 0.001) and in patients with IRAE (adjusted SHR: 2.14 [95% CI: 1.22; 3.75], p< 0.01).

CONCLUSION: The prevalence of VTE was 14.2% under ICIs. IRAE and combine treatment of nivolumab and ipilimumab were associated with VTE. The pathophysiological mechanisms are multiple and complex with a possible link to aberrant activation of the immune system.

PMID:37257835 | DOI:10.1055/s-0043-1769609

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PubMed articles on: Cancer & VTE/PE

A systemic review and meta-analysis of Aflibercept plus FOLFIRI regimen as a second-line treatment for metastatic colorectal cancer: A PRISMA compliant pooled analysis of randomized controlled trials and single arm studies to assess efficacy and safety

Crit Rev Oncol Hematol. 2023 May 29:104034. doi: 10.1016/j.critrevonc.2023.104034. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Aflibercept; a decoy receptor for vascular endothelial growth factors (VEGFs) and placental growth factor (PLGF), in combination with FOLFIRI (leucovorin calcium, fluorouracil, irinotecan hydrochloride) chemotherapy regime, was FDA approved in 2012 as second-line salvage chemotherapy for metastatic colorectal cancer (mCRC). This is the first systematic review, and meta-analysis-based evidence to determine the efficacy and safety of Aflibercept plus FOLFIRI regimen pooling randomized controlled trials and single-arm studies.

METHOD: PubMed, Cochrane library, Embase, and Clinical trial.gov were systematically searched for published randomized controlled trials, single-arm studies, and national patient programs on aflibercept plus FOLFIRI chemotherapy for the treatment of mCRC till 11/10/2022.

RESULT: Ten studies met the inclusion criteria comprising 1075 patients for efficacy studies and 2027 patients for safety studies. The pooled prevalences were 18% (95% CI, 5%-37%, p = 0.00) for 12m PFS and 61% (95% CI, 53% - 68%, p = 0.00) for 12m OS. The pooled prevalences were 69% (95% CI, 55% - 82%, p = 0.00) for any grade 3-4 toxicities, 10% (95% CI, 5% - 16%, p = 0.00) for grade 3-4 diarrhea, 13% (95% CI, 5% - 24%, p = 0.00) for grade 3-4 hypertension, 31% (95% CI, 22% - 40%, p = 0.00) for grade 3-4 neutropenia and 5% (95% CI, 2% - 7%, p = 0.00) for grade 3-4 venous thromboembolic event.

CONCLUSION: Our meta-analysis shows that the aflibercept plus FOLFIRI combination shows better survival efficacies however; it is also associated with more high-grade adverse events.

PMID:37257732 | DOI:10.1016/j.critrevonc.2023.104034

6 June 2023

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PubMed articles on: Cardio-Oncology

Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool

Thromb Res. 2023 May 13;228:54-60. doi: 10.1016/j.thromres.2023.05.008. Online ahead of print.

ABSTRACT

BACKGROUND: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs.

METHODS: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.

RESULTS: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life.

CONCLUSIONS: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

PMID:37276718 | DOI:10.1016/j.thromres.2023.05.008

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A Fondazione Italiana Linfomi cohort study of R-COMP vs R-CHOP in older patients with diffuse large B-cell lymphoma

Blood Adv. 2023 Jun 5:bloodadvances.2023009839. doi: 10.1182/bloodadvances.2023009839. Online ahead of print.

ABSTRACT

R-CHOP is the most commonly used regimen worldwide for the upfront treatment of diffuse large B-cell lymphoma (DLBCL). However, it is associated with significant cardiotoxicity, especially in older patients. The R-COMP regimen, with non-pegylated liposomal doxorubicin, may reduce the risk of cardiac events, but its efficacy has never been demonstrated in prospective trials. In this report, we describe the characteristics and outcome of DLBCL patients≥65 years prospectively enrolled in the Elderly Project by the Fondazione Italiana Linfomi and treated with full doses of R-CHOP or R-COMP per local practice. Starting from a dataset of 1163 cases, 383 (55%) were treated with R-CHOP and 308 (45%) with R-COMP. Patients treated with R-COMP were older (median age 76 vs 71 years), less frequently fit at simplified geriatric assessment (61% vs 88%, p<0.001),1, 32% vs 8%, p<0.001).

PMID:37276080 | DOI:10.1182/bloodadvances.2023009839

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PubMed articles on: Cardio-Oncology

Levels of NT‑proBNP in patients with cancer

Oncol Lett. 2023 May 16;26(1):280. doi: 10.3892/ol.2023.13866. eCollection 2023 Jul.

ABSTRACT

At present, it is well known that natriuretic peptides may be produced by cancer cells. Stimulation of N-terminal pro B-type natriuretic peptide (NT-proBNP) synthesis may be a reaction to activity of several proinflammatory cytokines. NT-proBNP is also a marker of myocardial damage during cardiotoxic chemotherapy by anthracyclines. The present study aimed to analyze the association between NT-proBNP and patient/disease characteristics in patients without cardiac symptoms. The present clinical study included 112 patients with cancer who were undergoing anticancer therapy between December 2017 and December 2021. From each patient, peripheral blood was obtained for detection of NT-proBNP before any therapy, after therapy and 1 year after the first sample. NT-proBNP was examined using an immunochemical method. The mean ± SEM value of NT-pro-BNP in the first, second and third sample was 561.0±75.1, 1,565.4±461.1 and 1,940.7±581.1 ng/l. A total of 15 (13.4%), 27 (24.1%) and 25 (30.1%) patients had elevated levels of NT-pro-BNP in the first, second and third sample above the normal value adjusted to age. It was observed that NT-proBNP was increased in older patients and in patients with progressive metastatic disease with poor prognosis. Patients with non-elevated NT-proBNP in the second and third sample had significantly improved OS compared with patients with elevated NT-proBNP [hazard ratio (HR), 0.47; 95% CI, 0.26-0.85; P=0.002 for the second sample; and HR, 0.29; 95% CI, 0.14-0.60; P=0.0000007, for the third sample]. The baseline NT-proBNP value was not prognostic for OS (HR, 0.98; 95% CI, 0.50-1.92; P=0.96). The present results suggest that the level of NT-proBNP was associated with the extent of oncologic disease. Higher levels were associated with progression of metastatic disease and shorter overall survival.

PMID:37274478 | PMC:PMC10236092 | DOI:10.3892/ol.2023.13866

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PubMed articles on: Cardio-Oncology

Radiation-induced circulating microRNAs linked to echocardiography parameters after radiotherapy

Front Oncol. 2023 May 18;13:1150979. doi: 10.3389/fonc.2023.1150979. eCollection 2023.

ABSTRACT

INTRODUCTION: Patients treated with radiotherapy to the chest region are at risk of cardiac sequelae, however, identification of those with greatest risk of complications remains difficult. Here, we sought to determine whether short-term changes in circulating miRNA expression are related to measures of cardiac dysfunction in follow-up.

MATERIALS AND METHODS: Two parallel patient cohorts were enrolled and followed up for 3 years after completion of RT to treat left-sided breast cancer. In the primary group (N=28) we used a a panel of 752 miRNAs to identify miRNAs associated with radiation and cardiac indices at follow up. In the second, independent cohort (N=56) we validated those candidate miRNAs with a targeted qPCR panel. In both cohorts. serum samples were collected before RT, 24h after the last dose and 1 month after RT; cardiac echocardiography was performed 2.5-3 year after RT.

RESULTS: Seven miRNAs in the primary group showed marked changes in serum miRNAs immediately after RT compared to baseline and associations with cardiopulmonary dose-volume histogram metrics. Among those miRNAs: miR-15b-5p, miR-22-3p, miR-424-5p and miR-451a were confirmed to show significant decrease of expression 24 hours post-RT in the validation cohort. Moreover, miR-29c, miR-451 and miR-424 were correlated with the end-diastolic diameter of the left ventricle, which was also confirmed in multivariable analysis adjusting for RT-associated factors.

CONCLUSION: We identified a subset of circulating miRNAs predictive for cardiac function impairment in patients treated for left-sided breast cancer, although longer clinical observation could determine if these can be used to predict major clinical endpoints.

PMID:37274244 | PMC:PMC10232985 | DOI:10.3389/fonc.2023.1150979

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PubMed articles on: Cardio-Oncology

Potential for cardiac toxicity with methylimidazolium ionic liquids

Ecotoxicol Environ Saf. 2023 Jan 1;249:114439. doi: 10.1016/j.ecoenv.2022.114439. Epub 2022 Dec 19.