Patients with lung cancer often face a heightened risk of thromboembolism, a serious condition encompassing both venous thromboembolism (VTE) and arterial thromboembolism (ATE). As immune checkpoint inhibitors (ICIs) become a standard treatment for lung cancer, understanding their association with these events is increasingly important for patient management. A recent retrospective study published in Frontiers in Pharmacology investigated the incidence and clinical risk factors for thromboembolism in lung cancer patients receiving ICIs.
Thromboembolism is a significant concern in oncology, contributing to increased morbidity, mortality, and healthcare costs. While previous research has indicated that various systemic cancer therapies can elevate VTE risk, the specific impact of ICIs, particularly on ATE, has been less comprehensively explored. This study aimed to bridge that knowledge gap by analysing a cohort of lung cancer patients undergoing ICI treatment.
Understanding Thromboembolism in Lung Cancer Patients on ICIs
The study, conducted at Chongqing University Cancer Hospital, involved a retrospective analysis of 504 lung cancer patients who received ICIs between January 2019 and December 2022. Researchers focused on a critical risk window, defined as the period from the first ICI dose to four weeks after the final dose, to specifically capture treatment-related thromboembolic events.
Key findings from the study include:
- During a mean follow-up of 27.2 months, thromboembolism occurred in 104 out of 504 patients (20.6%) while on immunotherapy.
- Among those who experienced thromboembolism, 90.4% developed VTE, 3.9% experienced ATE, and 5.8% had both VTE and ATE.
- The cumulative incidence of all thromboembolic events was 10.1% at 3 months, rising to 20.6% at 24 months.
- For VTE specifically, the cumulative incidence was 9.1% at 3 months and 18.7% at 24 months.
- ATE events showed a cumulative incidence of 1.0% at 3 months and 2.0% at 12 months.
These figures suggest a notable incidence of VTE and a discernible incidence of ATE in this patient population receiving ICIs.
Identified Risk Factors for Thromboembolism
The multivariate analysis conducted by the researchers identified several independent variables associated with an increased risk of thromboembolism:
- An age-adjusted Charlson comorbidity index (ACCI) greater than 8.
- The presence of a central venous catheter (CVC).
- D-dimer levels exceeding 0.5 mg/L.
- The presence of brain metastases at the start of treatment.
These factors provide clinicians with potential indicators to identify lung cancer patients on ICIs who may be at a higher risk of developing thromboembolic events.
Clinical Implications for Patient Care
The findings from this study suggest that immune checkpoint inhibitors are associated with a considerable incidence of thromboembolism in lung cancer patients, particularly VTE, but also ATE. The identification of specific risk factors offers a pathway for clinicians to assess individual patient risk more effectively.
According to the researchers, these insights underscore the importance of considering targeted thromboprophylaxis strategies for high-risk patients. Such proactive measures may help to reduce the burden of thromboembolic events and potentially support overall outcomes for lung cancer patients undergoing immunotherapy. Further research, including larger prospective studies, could help refine these risk assessments and prophylaxis guidelines.
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