Dataset Information

Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19.

ABSTRACT:

Importance

Systematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking.

Objective

To assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer.

Design, setting, and participants

This registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022.

Exposure

Treatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs], immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19.

Main outcomes and measures

Main outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up.

Results

Of 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR], 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13).

Conclusions and relevance

In this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. 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.

SUBMITTER: Gulati S

PROVIDER: S-EPMC10436185 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19.

Gulati Shuchi S Hsu Chih-Yuan CY Shah Surbhi S Shah Pankil K PK Zon Rebecca R Alsamarai Susan S Awosika Joy J El-Bakouny Ziad Z Bashir Babar B Beeghly Alicia A Berg Stephanie S de-la-Rosa-Martinez Daniel D Doroshow Deborah B DB Egan Pamela C PC Fein Joshua J Flora Daniel B DB Friese Christopher R CR Fromowitz Ariel A Griffiths Elizabeth A EA Hwang Clara C Jani Chinmay C Joshi Monika M Khan Hina H Klein Elizabeth J EJ Heater Natalie Knox NK Koshkin Vadim S VS Kwon Daniel H DH Labaki Chris C Latif Tahir T McKay Rana R RR Nagaraj Gayathri G Nakasone Elizabeth S ES Nonato Taylor T Polimera Hyma V HV Puc Matthew M Razavi Pedram P Ruiz-Garcia Erika E Saliby Renee Maria RM Shastri Aditi A Singh Sunny R K SRK Tagalakis Vicky V Vilar-Compte Diana D Weissmann Lisa B LB Wilkins Cy R CR Wise-Draper Trisha M TM Wotman Michael T MT Yoon James J JJ Mishra Sanjay S Grivas Petros P Shyr Yu Y Warner Jeremy L JL Connors Jean M JM Shah Dimpy P DP Rosovsky Rachel P RP

JAMA oncology 20231001 10

<h4>Importance</h4>Systematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking.<h4>Objective</h4>To assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer.<h4>Design, setting, and participants</h4>This registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-conf ...[more]

PMID: 37589970

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Dataset Information

Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19.

Importance

Objective

Design, setting, and participants

Exposure

Main outcomes and measures

Results

Conclusions and relevance

Publications

Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19.

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