Takada Ryo, Fujiwara Miki, Maki Masatoshi, Takahashi Yoko, Tamura Koji
Department of Hospital Pharmacy, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, 720-8520, Fukuyama-city, Hiroshima, Japan.
J Pharm Health Care Sci. 2023 Jul 3;9(1):22. doi: 10.1186/s40780-023-00291-0.
While cancer is a risk factor for developing thromboembolism, so is the use of molecularly targeted therapies. This study aimed to determine whether thromboembolism incidence differed between vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) inhibitor use in patients with unresectable advanced or recurrent colorectal cancer, and to compare the risk of thromboembolism caused by cancer and the use of molecular targeted therapy drugs.
We retrospectively evaluated patients with unresectable advanced or recurrent colorectal cancer who were treated with a cytotoxic anticancer drug and a VEGF or EGFR inhibitor combination between April 2016 and October 2021. Patients were compared in terms of the regimen administered, thromboembolism occurrence during the first-line treatment period, patient background, and clinical laboratory values. Of the 179 included patients, 12 of 134 (8.9%) in the VEGF-inhibitor group and 8 of 45 (17.8%) in the EGFR-inhibitor group developed thromboembolism, with no significant difference between the groups (P = 0.11). There was no significant difference in time to thromboembolism between patients in the VEGF- inhibitor group and patients in the EGFR-inhibitor group (P = 0.206). The cutoff value determined by a receiver operating characteristic analysis for the occurrence of thromboembolism was one point. Multivariate analysis using the occurrence of thromboembolism as the response variable identified at least one risk factor for thromboembolism (odds ratio = 4.17, P = 0.006, 95% confidence interval = 1.51-11.50). Molecular targeted therapies were not identified as a risk factor.
Although the small sample size, there was no difference in the incidence of thromboembolism between the two molecular-targeted therapies in first-line treatment of patients with unresectable advanced or recurrent colorectal cancer. Our results suggest that risk factors for thromboembolism may be more strongly influenced by cancer itself than by the use of molecularly targeted therapies.
虽然癌症是发生血栓栓塞的一个风险因素，但分子靶向治疗的使用也是如此。本研究旨在确定在不可切除的晚期或复发性结直肠癌患者中，血管内皮生长因子（VEGF）抑制剂和表皮生长因子受体（EGFR）抑制剂的使用在血栓栓塞发生率上是否存在差异，并比较癌症和分子靶向治疗药物的使用所导致的血栓栓塞风险。
我们回顾性评估了2016年4月至2021年10月期间接受细胞毒性抗癌药物与VEGF或EGFR抑制剂联合治疗的不可切除的晚期或复发性结直肠癌患者。比较了患者的给药方案、一线治疗期间血栓栓塞的发生情况、患者背景以及临床实验室值。在纳入的179例患者中，VEGF抑制剂组134例中有12例（8.9%）发生血栓栓塞，EGFR抑制剂组45例中有8例（17.8%）发生血栓栓塞，两组之间无显著差异（P = 0.11）。VEGF抑制剂组患者与EGFR抑制剂组患者发生血栓栓塞的时间无显著差异（P = 0.206）。通过对血栓栓塞发生情况进行的受试者工作特征分析确定的临界值为1分。以血栓栓塞的发生作为反应变量的多变量分析确定了至少一个血栓栓塞的风险因素（比值比 = 4.17，P = 0.006，95%置信区间 = 1.51 - 11.50）。未将分子靶向治疗确定为风险因素。
尽管样本量较小，但在不可切除的晚期或复发性结直肠癌患者的一线治疗中，两种分子靶向治疗在血栓栓塞发生率上没有差异。我们的结果表明，血栓栓塞的风险因素可能受癌症本身的影响比受分子靶向治疗的使用影响更大。
