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Venous thromboembolism during preoperative chemotherapy in the CRITICS gastric cancer trial.

ABSTRACT: BACKGROUND:The occurrence of a venous thromboembolism (VTE) is common in patients with cancer. Gastric cancer has been associated with one of the highest risks for VTE. Chemotherapy, especially cisplatin has been associated with a high VTE risk. In this study, risk factors for VTE occurrence and their potential impact on subsequent therapeutic interventions were investigated in patients who underwent preoperative chemotherapy, in the CRITICS gastric cancer trial. PATIENTS AND METHODS:Patients with resectable gastric cancer were preoperatively treated with three cycles of 3-weekly epirubicin, cisplatin or oxaliplatin, and capecitabine (ECC/EOC). VTE was defined as any thrombus in the venous system, excluding superficial and/or device related VTEs. Potential risk factors were analyzed in a multivariable regression model with age, gender, Body Mass Index (BMI), tumor localization, Lauren classification, type of chemotherapy (ECC/EOC), (cardiovascular) comorbidity, and previous VTE as independent risk factors. The impact of VTE on completion rate of preoperative chemotherapy, surgical resection rate, postoperative complications, and start of postoperative therapy were investigated. RESULTS:Of 781 patients, 78 (10%) of 781 patients developed a VTE during preoperative chemotherapy. On multivariable analysis, BMI ? 30 kg/m2 and previous VTE were associated with VTE occurrence (reference BMI < 25 kg/m2 ; OR 2.190; 95% CI 1.152-4.164; P = .017/previous VTE; OR 3.617; 95% CI 1.201-10.890; P = .022). Treatment with cisplatin was, compared to oxaliplatin, not significantly associated with VTE occurrence (OR 1.535; 95% CI 0.761-3.094; P = .231). VTE occurrence did not affect completion of preoperative chemotherapy, surgical resection rate, postoperative complications, or start of postoperative therapy. CONCLUSION:High BMI and previous VTE were independent risk factors for VTE occurrence during preoperative chemotherapy in patients with resectable gastric cancer. VTE occurrence in the preoperative setting did not affect receipt of further treatment.

SUBMITTER: Slagter AE

PROVIDER: S-EPMC7520268 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Venous thromboembolism during preoperative chemotherapy in the CRITICS gastric cancer trial.

Slagter Astrid E AE Sikorska Karolina K Grootscholten Cecile C van Laarhoven Hanneke W M HWM Lind Pehr P Nordsmark Marianne M Meershoek-Klein Kranenbarg Elma E van de Velde Cornelis J H CJH van Grieken Nicole C T NCT van Sandick Johanna W JW Jansen Edwin P M EPM Verheij Marcel M Cats Annemieke A

Cancer medicine 20200731 18

<h4>Background</h4>The occurrence of a venous thromboembolism (VTE) is common in patients with cancer. Gastric cancer has been associated with one of the highest risks for VTE. Chemotherapy, especially cisplatin has been associated with a high VTE risk. In this study, risk factors for VTE occurrence and their potential impact on subsequent therapeutic interventions were investigated in patients who underwent preoperative chemotherapy, in the CRITICS gastric cancer trial.<h4>Patients and methods< ...[more]

PMID: 32735752

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Project description:Simple Summary Perioperative chemotherapy is the current standard treatment for patients with resectable gastric cancer. Either cisplatin or oxaliplatin could be part of the chemotherapy regimen, of which oxaliplatin is currently most used in the standard treatment. Evidence to choose oxaliplatin over cisplatin in the curative setting is limited. In this study, we compared cisplatin versus oxaliplatin in patients with resectable gastric cancer treated with pre- and postoperative chemotherapy. Adverse events were not different for patients who received cisplatin versus those who received oxaliplatin, nor was compliance with the treatment regimen. We could not detect survival differences between patients treated with cisplatin versus oxaliplatin. Diarrhea more frequently impacted patients treated with oxaliplatin than patients treated with cisplatin. As hydration is not needed for oxaliplatin, it is more practical to use in daily care. In conclusion, both cisplatin and oxaliplatin are legitimate options as part of systemic treatment in patients with resectable gastric cancer. Abstract (1) Background: Perioperative chemotherapy is the current standard treatment for patients with resectable gastric cancer. Based on studies in patients with metastatic gastric cancer, oxaliplatin has replaced cisplatin in the curative setting as well. However, evidence to prefer oxaliplatin over cisplatin in the curative setting is limited. (2) Methods: We compared patient-related and tumor-related outcomes for cisplatin versus oxaliplatin in patients with resectable gastric cancer treated with perioperative chemotherapy in the CRITICS trial. (3) Results: Preoperatively, 632 patients received cisplatin and 149 patients received oxaliplatin. Preoperative severe toxicity was encountered in 422 (67%) patients who received cisplatin versus 89 (60%) patients who received oxaliplatin (p = 0.105). Severe neuropathy was observed in 5 (1%) versus 6 (4%; p = 0.009) patients, respectively. Postoperative severe toxicity occurred in 109 (60%) versus 26 (51%) (p = 0.266) patients; severe neuropathy in 2 (1%) versus 2 (4%; p = 0.209) for patients who received cisplatin or oxaliplatin, respectively. Diarrhea impacted the quality of life more frequently in patients who received oxaliplatin compared to cisplatin. Complete or near-complete pathological response was achieved in 94 (21%) versus 16 (15%; p = 0.126) patients who received cisplatin or oxaliplatin, respectively. Overall survival was not significantly different in both groups (p = 0.300). (4) Conclusions: Both cisplatin and oxaliplatin are legitimate options as part of systemic treatment in patients with resectable gastric cancer.

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Venous thromboembolism during preoperative chemotherapy in the CRITICS gastric cancer trial.

Publications

Venous thromboembolism during preoperative chemotherapy in the CRITICS gastric cancer trial.

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