Fowler Cosmo, Pastores Stephen M
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
J Clin Med. 2025 Jul 11;14(14):4926. doi: 10.3390/jcm14144926.
Venous thromboembolism (VTE) represents a significant complication of cancer immunotherapy, with emerging evidence suggesting distinct pathophysiological mechanisms compared to traditional chemotherapy-associated thrombosis. This narrative review examines the epidemiology and pathogenesis of VTE in patients receiving immunotherapies for cancer including immune checkpoint inhibitors (ICIs), chimeric antigen receptor (CAR) T-cell therapy, bispecific T-cell engagers (BiTEs), among others. Real-world studies demonstrate a wide range of VTE incidence rates in ICI recipients, with potential mechanisms including exacerbated underlying interleukin-8-mediated inflammatory pathways and consequent neutrophil extracellular trap (NET) formation. CAR T-cell therapy is associated with unique hemostatic challenges, including concurrent thrombotic and bleeding risks related to cytokine release syndrome. Current risk assessment tools show limited predictive utility in patients receiving immunotherapies for cancer, highlighting the need for novel stratification models. Future research priorities include developing immunotherapy-specific risk prediction tools, elucidating mechanistic pathways linking immune activation to thrombosis, and establishing evidence-based and tailored thromboprophylaxis strategies. As cancer immunotherapy continues to evolve, understanding and mitigating thrombotic complications remains crucial for optimizing patient outcomes.
静脉血栓栓塞（VTE）是癌症免疫治疗的一种重要并发症，新出现的证据表明，与传统化疗相关的血栓形成相比，其病理生理机制有所不同。这篇叙述性综述探讨了接受癌症免疫治疗（包括免疫检查点抑制剂（ICI）、嵌合抗原受体（CAR）T细胞疗法、双特异性T细胞衔接器（BiTE）等）的患者中VTE的流行病学和发病机制。真实世界研究表明，ICI接受者的VTE发病率范围广泛，潜在机制包括加剧潜在的白细胞介素-8介导的炎症途径以及随后的中性粒细胞胞外陷阱（NET）形成。CAR T细胞疗法带来了独特的止血挑战，包括与细胞因子释放综合征相关的并发血栓形成和出血风险。目前的风险评估工具在接受癌症免疫治疗的患者中显示出有限的预测效用，凸显了对新型分层模型的需求。未来的研究重点包括开发免疫治疗特异性风险预测工具、阐明将免疫激活与血栓形成联系起来的机制途径，以及建立基于证据的定制化血栓预防策略。随着癌症免疫治疗的不断发展，理解和减轻血栓形成并发症对于优化患者预后仍然至关重要。
