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免疫检查点抑制剂治疗后发生静脉血栓栓塞事件的癌症患者的特征和结局

Characteristics and Outcomes of Cancer Patients With Venous Thromboembolic Events After Treatment With Immune Checkpoint Inhibitors.

作者信息

Dutra Barbara, Garcia-Rodriguez Victor, Garcia Rogelio, Szafron David, Abraham Fiyinfoluwa, Khurana Shruti, Lockhart Jonathan, Amin Rajan, Wang Yinghong, Thomas Anusha

机构信息

Department of Internal Medicine, The University of Texas Health Science Center.

Department of Internal Medicine.

出版信息

Am J Clin Oncol. 2023 Mar 1;46(3):94-100. doi: 10.1097/COC.0000000000000981. Epub 2023 Feb 3.

Abstract

OBJECTIVE

This study aimed to describe the clinical characteristics and outcomes of patients with venous thromboembolism (VTE) after Immune checkpoint inhibitors (ICI), focusing on patients with gastrointestinal (GI) immune-related adverse events (irAE).

METHODS

In this retrospective, single-center study, we report the clinical outcomes of adult cancer patients who developed a VTE within 2 years of ICI initiation. Patients were excluded if alternate causes of VTE were present apart from malignancy and cancer therapy. The cohort was classified into those with GI-irAE, non-GI-irAE, and no irAE. A control group with ICI exposure without irAE and VTE was selected for comparative analysis.

RESULTS

Of all ICI-treated patients, 1891 (17.2%) were diagnosed with VTE. In all, 501 (4.6%) had no etiology for VTE aside from malignancy and cancer therapy. Of these, 137 patients were included and classified as: 44 GI-irAE, 42 non-GI-irAE, and 51 no irAE. Chemotherapy within 6 months of ICI therapy was associated with increased VTE risk. There was no difference in the clinical course between those exposed to chemotherapy versus ICI therapy alone, time from ICI initiation to VTE, and VTE type, recurrence, or related hospitalization. While there was no difference in VTE-related mortality, the GI-irAE group was associated with lower all-cause mortality and superior overall survival.

CONCLUSION

Combined ICI and chemotherapy use increased VTE risk. There is a similar disease course of VTE after ICI exposure, regardless of other irAEs. Co-existing GI-irAE with VTE is associated with superior overall survival. Prospective studies are needed to evaluate the relationship between ICI therapy and VTE and irAE impact on VTE outcomes.

摘要

目的

本研究旨在描述免疫检查点抑制剂(ICI)治疗后发生静脉血栓栓塞症(VTE)患者的临床特征及结局,重点关注发生胃肠道(GI)免疫相关不良事件(irAE)的患者。

方法

在这项回顾性单中心研究中,我们报告了在ICI开始治疗后2年内发生VTE的成年癌症患者的临床结局。如果除恶性肿瘤和癌症治疗外还存在VTE的其他病因,则将患者排除。该队列分为发生GI-irAE、非GI-irAE和未发生irAE的患者。选择一组接受ICI治疗但未发生irAE和VTE的患者作为对照组进行比较分析。

结果

在所有接受ICI治疗的患者中,1891例(17.2%)被诊断为VTE。总共有501例(4.6%)除恶性肿瘤和癌症治疗外没有VTE的病因。其中,137例患者被纳入并分类为:44例发生GI-irAE,42例发生非GI-irAE,51例未发生irAE。ICI治疗后6个月内进行化疗与VTE风险增加相关。接受化疗与单独接受ICI治疗的患者在临床病程、从ICI开始治疗到发生VTE的时间、VTE类型、复发或相关住院方面没有差异。虽然VTE相关死亡率没有差异,但GI-irAE组的全因死亡率较低,总生存期较好。

结论

联合使用ICI和化疗会增加VTE风险。ICI治疗后VTE的病程相似,无论是否存在其他irAE。VTE合并GI-irAE与较好的总生存期相关。需要进行前瞻性研究以评估ICI治疗与VTE之间的关系以及irAE对VTE结局的影响。

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