Summary
Women who are on neoadjuvant chemotherapy (NACT) for advanced ovarian cancer may have increased risk for blood clots, according to a study presented at ASCO 2020 virtual scientific sessions (Abstract 6073).
“The overall risk of developing venous thrombosis (VTE) in our cohort of ovarian cancer patients receiving NACT was 15 percent,” senior author Elizabeth Jewell, MD, told Oncology Times. Jewell is a gynecologic oncologist and surgeon at Memorial Sloan Kettering Cancer Center in New York City.
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Original Article
Neoadjuvant Chemotherapy & Increase of Blood Clots in Ovarian Cancer
Oncology Times
By Veronica Hackethal
Women who are on neoadjuvant chemotherapy (NACT) for advanced ovarian cancer may have increased risk for blood clots, according to a study presented at ASCO 2020 virtual scientific sessions (Abstract 6073).
“The overall risk of developing venous thrombosis (VTE) in our cohort of ovarian cancer patients receiving NACT was 15 percent,” senior author Elizabeth Jewell, MD, told Oncology Times. Jewell is a gynecologic oncologist and surgeon at Memorial Sloan Kettering Cancer Center in New York City.
“The highest risk time period of developing VTE was during NACT, with lower rates of VTE development after interval debulking surgeries and postoperative chemotherapy,” she noted.
The findings are noteworthy because prophylactic anticoagulation is not traditionally used during induction of NACT.
Study Details
In the study, researchers conducted a retrospective analysis of data from a prospectively maintained ovarian cancer database. The analysis included 233 women who had advanced ovarian cancer and received NACT treatment at Memorial Sloan Kettering Cancer Center between April 2015 and September 2018. Women who presented with past history of VTE were on anticoagulation before diagnosis, or those who were seeking a second opinion were excluded. Researchers looked at incidence of newly diagnosed deep venous thrombosis (DVT) or pulmonary embolism (PE) among included women.
Overall, 15 percent (35/233) of these women developed a VTE during treatment. Most blood-clotting events (77%, 27/35) occurred among women who were receiving NACT in preparation for debulking surgery: almost 12 percent (11.6%, 27/233) of these women developed a VTE. In comparison, VTEs developed in 2.6 percent (6/233) of women during the intraoperative and 30-day post-surgical period, and 0.9 percent (2/233) during the adjuvant chemotherapy phase more than 30 days after surgery.
The only risk factor that was significantly associated with increased risk for VTE was FIGO stage IV disease (a combined classification for ovarian, fallopian tube, and peritoneum cancer), which was associated with 3.9 times increased risk of VTE (OR 3.9, 95% CI 1.2-3.6, p = 0.03). Age, tumor histology, germline mutation, and Khorana scores were not significantly linked to VTE.
Jewell highlighted the lack of association between Khorana scores and VTE. Khorana scores are the best known tool for predicting risk for VTE in patients with cancer. In other cancer types, Khorana scores can be used to identify patients who could benefit from prophylactic anticoagulation.
“Further research regarding the selection criteria and timing of thromboprophylaxis for this patient population is warranted before initiating routine anticoagulation treatment for this patient cohort,” she said. “Future research should also explore the safety and compliance with oral versus injectable anticoagulation [in this patient population].”
Veronica Hackethal is a contributing writer.