Do Antiangiogenics Promote Clot Instability? Data from the TESEO Prospective Registry and Caravaggio Clinical Trial

Autores de IDIVAL

• 

  Eva Martínez De Castro

  Autor

  eva.martinezde@scsalud.es

Autores ajenos al IDIVAL

• Carmona-Bayonas A
• Verso M
• Sánchez Cánovas M
• Rubio Pérez J
• García de Herreros M
• Martínez de Prado P
• Fernández Pérez I
• Quintanar Verdúguez T
• Obispo B
• Pachón V
• Gómez D
• Ortega L
• Serrano Moyano M
• Brozos EM
• Biosca M
• Antonio M
• Teijeira Sánchez L
• Hernández Pérez C
• Cumplido Burón JD
• Martínez Lago N
• García Pérez E
• Muñoz Langa J
• Perez-Segura P
• Jiménez-Fonseca P
• Agnelli G
• Muñoz A

Abstract

Background Venous thromboembolism (VTE) is a common complication in cancer patients. Much of its morbidity stems from the development of fatal pulmonary embolisms (PE). Little is known about the factors involved in clot stability, with angiogenesis possibly being implicated. Methods The database is from the TESEO prospective registry that recruits cancer patients with VTE from 41 Spanish hospitals. Independent validation was conducted in a cohort from the Caravaggio trial. The objective is to evaluate the association between exposure to antiangiogenic therapies and the PE/VTE proportion in oncological patients. Results In total, 1,536 subjects were evaluated; 58.4% ( n = 894) had a PE and 7% ( n = 108) received antiangiogenic therapy (bevacizumab in 75%). The PE/VTE proportion among antiangiogenic-treated individuals was 77/108 (71.3%) versus 817/1,428 (57.2%) among those receiving other alternative therapies ( p = 0.004). The effect of the antiangiogenics on the PE/VTE proportion held up across all subgroups except for active smokers or those with chronic obstructive pulmonary disease. Exposure to antiangiogenics was associated with increased PEs, odds ratio (OR) 2.27 (95% CI, 1.42-3.63). In the Caravaggio trial, PE was present in 67% of the individuals treated with antiangiogenics, 50% of those who received chemotherapy without antiangiogenic treatment, and 60% without active therapy ( p = 0.0016). Conclusion Antiangiogenics are associated with increased proportion of PE in oncological patients with VTE. If an effect on clot stability is confirmed, the concept of thrombotic risk in cancer patients should be reconsidered in qualitative terms.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).