Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada.
Curr Oncol. 2023 Mar 4;30(3):3032-3046. doi: 10.3390/curroncol30030230.
Immune checkpoint inhibitors (ICIs) target programmed cell death (PD) 1 receptor and its ligand PD-L1, and have become an integral part of treatment regimens in many cancers including lung cancer, renal cell carcinoma, melanoma, and more. Cancer is associated with a significantly increased risk of venous thromboembolism compared to non-cancer patients, and the risks increase further with anticancer therapies including ICIs. Cancer-associated thrombosis can lead to hospitalizations, delayed cancer treatment, and mortality. While thrombosis was not reported as a major complication in initial clinical trials leading to the approval of ICIs, emerging evidence from post-marketing studies revealed concerning risks of thrombosis in patients receiving ICIs. However, results remained heterogenous given differences in study designs and populations. Recent studies also showed that C-reactive protein dynamics might be an easily accessible biomarker for thrombosis and disease response in this population. In addition, early findings indicated that a commonly used anticoagulant for cancer-associated thrombosis, factor Xa inhibitors, might have potential synergistic antitumor effects when combined with ICIs. Herein we will review the current literature on the incidence, risk factors, and management of thrombosis in patients with cancer receiving ICIs. We aim to provide valuable information for clinicians in managing these patients.
免疫检查点抑制剂（ICIs）针对程序性死亡（PD）1 受体及其配体 PD-L1，已成为包括肺癌、肾细胞癌、黑色素瘤等多种癌症治疗方案的重要组成部分。与非癌症患者相比，癌症患者发生静脉血栓栓塞的风险显著增加，而包括 ICI 在内的抗癌治疗则会进一步增加这种风险。癌症相关性血栓可导致住院、癌症治疗延迟和死亡。虽然在导致 ICI 获批的最初临床试验中并未报告血栓形成是主要并发症，但来自上市后研究的新证据显示，接受 ICI 治疗的患者存在令人担忧的血栓形成风险。然而，鉴于研究设计和人群的差异，结果仍然存在异质性。最近的研究还表明，C 反应蛋白动力学可能是该人群中血栓形成和疾病反应的一种易于获取的生物标志物。此外，早期研究表明，一种常用于癌症相关性血栓形成的抗凝剂，即因子 Xa 抑制剂，与 ICI 联合使用时可能具有潜在的协同抗肿瘤作用。本文将综述目前关于癌症患者接受 ICI 治疗时血栓形成的发生率、风险因素和管理的文献。我们旨在为临床医生管理这些患者提供有价值的信息。
