Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19
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Published:2023-10-01
Issue:10
Volume:9
Page:1390
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ISSN:2374-2437
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Container-title:JAMA Oncology
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language:en
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Short-container-title:JAMA Oncol
Author:
Gulati Shuchi12, Hsu Chih-Yuan3, Shah Surbhi4, Shah Pankil K.5, Zon Rebecca6, Alsamarai Susan7, Awosika Joy2, El-Bakouny Ziad8, Bashir Babar9, Beeghly Alicia10, Berg Stephanie11, de-la-Rosa-Martinez Daniel12, Doroshow Deborah B.13, Egan Pamela C.14, Fein Joshua7, Flora Daniel B.15, Friese Christopher R.16, Fromowitz Ariel17, Griffiths Elizabeth A.18, Hwang Clara19, Jani Chinmay20, Joshi Monika21, Khan Hina14, Klein Elizabeth J.14, Heater Natalie Knox11, Koshkin Vadim S.22, Kwon Daniel H.22, Labaki Chris8, Latif Tahir2, McKay Rana R.23, Nagaraj Gayathri24, Nakasone Elizabeth S.25, Nonato Taylor23, Polimera Hyma V.21, Puc Matthew26, Razavi Pedram23, Ruiz-Garcia Erika12, Saliby Renee Maria8, Shastri Aditi17, Singh Sunny R. K.27, Tagalakis Vicky28, Vilar-Compte Diana12, Weissmann Lisa B.20, Wilkins Cy R.2930, Wise-Draper Trisha M.2, Wotman Michael T.13, Yoon James J.16, Mishra Sanjay31, Grivas Petros25, Shyr Yu3, Warner Jeremy L.1031, Connors Jean M.32, Shah Dimpy P.5, Rosovsky Rachel P.33, Gandhi Rikin34, Gartrell Benjamin A.34, Goel Sanjay34, Halmos Balazs34, Makower Della F.34, O' Sullivan Darciann34, Ohri Nitin34, Sica R. Alejandro34, Verma Amit K.34, Butt Omar34, Fiala Mark A.34, Henderson Jeffrey P.34, Monahan Ryan S.34, Stockerl-Goldstein Keith E.34, Zhou Alice Y.34, Bitran Jacob D.34, Hallmeyer Sigrun34, Mundt Daniel34, Pandravada Sasirekha34, Papaioannou Philip V.34, Patel Mauli34, Streckfuss Mitrianna34, Tadesse Eyob34, Thompson Michael A.34, Lammers Philip E.34, Loree Jonathan M.34, Yu Irene S.34, Bindal Poorva34, Lam Barbara34, Peters Mary Linton B.34, Piper-Vallillo Andrew J.34, Arvanitis Panos34, Egan Pamela C.34, Farmakiotis Dimitrios34, Olszewski Adam J.34, Vieira Kendra34, Angevine Anne H.34, Bar Michael H.34, Del Prete Salvatore A.34, Fiebach Maryann Z.34, Gulati Anthony P.34, Hatton Edward34, Houston Kaly34, Rose Suzanne J.34, Steve Lo K. M.34, Stratton Jamie34, Weinstein Paul L.34, Garcia Jorge A.34, Routy Bertrand34, Hoyo-Ulloa Irma34, Gupta Shilpa34, Nizam Amanda34, Pennell Nathan A.34, Sharifi Nima34, Hoppenot Claire34, Li Ang34, Bitterman Danielle S.34, Choueiri Toni K.34, Connors Jean M.34, Demetri George D.34, El Zarif Talal34, Florez Narjust34, Freeman Dory A.34, Giordano Antonio34, Morgans Alicia K.34, Nohria Anju34, Tolaney Sara M.34, Van Allen Eliezer M.34, Xu Wenxin Vincent34, Halabi Susan34, Zhang Tian34, Dzimitrowicz Hannah34, Leighton John C.34, Graber Jerome J.34, Hawley Jessica E.34, Loggers Elizabeth T.34, Lyman Gary H.34, Lynch Ryan C.34, Portuguese Andrew J.34, Schweizer Michael T.34, Su Christopher T.34, Tachiki Lisa34, Vinayak Shaveta34, Wagner Michael J.34, Yeh Albert34, Dansoa Yvonne34, Gatson Na Tosha N.34, Makary Mina34, Manikowski Jesse J.34, Vadakara Joseph34, Yossef Kristena34, Beckerman Jennifer34, Goyal Sharad34, Messing Ian34, Provenzano Destie34, Rao Yuan James34, Rosenstein Lori J.34, Steffes Dawn R.34, Clement Jessica M.34, Cosin Jonathan A.34, Daher Ahmad34, Dailey Mark E.34, Elias Rawad34, Eton Omar E.34, Hosmer Wylie34, Hsu Emily34, Jayaraj Asha34, Mather Jeff34, Menendez Alvaro G.34, Nadkarni Rajani34, Serrano Oscar K.34, Yu Peter Paul34, Gadgeel Shirish M.34, Tejwani Sheela34, Accordino Melissa K.34, Bhutani Divaya34, Bodin Brianne E.34, Hershman Dawn L.34, Ingham Matthew34, Khan Shaheer A.34, Masson Cynthia34, Schwartz Gary K.34, Alexander Mariam34, Matar Sara34, Reuben Daniel Y.34, Bernicker Eric H.34, Deeken John F.34, Jeffords Kelly J.34, Shafer Danielle34, Cárdenas-Delgado Ana I.34, Cuervo Campos Rogelio34, De-la-Rosa-Martinez Daniel34, Ramirez Ana34, Valdez-Reyes Nadia Melissa34, Gill David M.34, Lewis Mark A.34, Low Clarke A.34, Rhodes Terence D.34, Jones Michelle M.34, Mansoor Abdul-Hai34, Mashru Sandeep H.34, Werner Mica A.34, Cohen Aaron M.34, Hayes-Lattin Brandon M.34, McWeeney Shannon34, Nemecek Eneida R.34, Williamson Staci P.34, Lewis Grant C.34, Smith Stephanie J.34, Akhtari Mojtaba34, Castillo Dan R.34, Cortez Kimberly34, Park Kyu34, Reeves Mark E.34, Berg Stephanie34, O'Connor Timothy E.34, Altman Jessica34, Gurley Michael34, Mulcahy Mary F.34, Wehbe Firas H.34, Durbin Eric B.34, Kulkarni Amit A.34, Nelson Heather H.34, Ramesh Vidhyalakshmi34, Sachs Zohar34, Wilson Grace34, Bardia Aditya34, Boland Genevieve34, Gainor Justin F.34, Peppercorn Jeffrey34, Reynolds Kerry L.34, Zubiri Leyre34, Campian Jian Li34, Smith Katherine E.34, Bekaii-Saab Tanios S.34, Desai Aakash34, Halfdanarson Thorvardur R.34, Joyner Michael J.34, Riaz Irbaz B.34, Senefeld Jonathon W.34, Williams Colt34, Bonnen Mark34, Mahadevan Daruka34, Ramirez Amelie G.34, Salazar Mary34, Wang Chen-Pin34, Mesa Ruben A.34, Bouganim Nathaniel34, Elkrief Arielle34, Moria Feras34, Panasci Justin34, Papenburg Jesse34, Vinh Donald C.34, Nanchal Rahul34, Singh Harpreet34, Bahadur Nadia34, Bao Ting34, Nambiar Puja H.34, O’Cearbhaill Roisin E.34, Papadopoulos Esperanza B.34, Philip John34, Riely Gregory J.34, Robson Mark34, Rosenberg Jonathan E.34, Schoenfeld Adam J.34, Tamimi Rulla34, Cerrone Kim34, Dill Jennifer34, Faller Bryan A.34, Ajmera Archana34, Brouha Sharon S.34, Choi Sharon34, Hsiao Albert34, Reid Erin G.34, Bhatt Padmanabh S.34, Mariano Melissa G.34, Thomson Carey C.34, Glace Mary (Grace)34, Knoble Jeanna L.34, Rink Cameron34, Zacks Rosemary34, Blau Sibel H.34, Brown CarrieAnn34, Namburi Swathi34, Pomerantz Lauren D.34, Rovito Marc A.34, Advani Pragati E.34, Cronin Tara34, Fleissner Bridget34, Goel Shipra34, Gopalakrishnan Dharmesh34, Hernandez-Ilizaliturri Francisco34, Jain Prantesh34, Kariapper Ariffa34, Levine Ellis34, Moffitt Melissa34, O'Connor Tracey L.34, Puzanov Igor34, Smith Laurie J.34, Wicher Camille P.34, Zsiros Emese34, Jabbour Salma K.34, Misdary Christian F.34, Shah Mansi R.34, Batist Gerald34, Cook Erin34, Esfahani Khashayar34, Ferrario Cristiano34, Lau Susie34, Ma Kim34, Miller Wilson H.34, Rudski Lawrence34, Santos Dutra Miriam34, Wilchesky Machelle34, Mahmood Sana Z.34, McNair Christopher34, Mico Vasil34, Rivera Andrea Verghese34, Dixon Becky34, Heilman Hannah34, Logan Barbara B.34, Mandapakala Chaitanya34, Cabebe Elwyn C.34, Glover Michael J.34, Jha Alokkumar34, Khaki Ali Raza34, Nagpal Seema34, Schapira Lidia34, Shah Sumit A.34, Wu Julie Tsu-Yu34, Subbiah Suki34, Whaley David34, Lopes Gilberto de Lima34, de Cardenas Karen34, Russell Karen34, Stith Brittany34, Taylor Sharona34, Klamerus Justin F.34, Revankar Sanjay G.34, Addison Daniel34, Chen James L.34, Gatti-Mays Margaret E.34, Jhawar Sachin R.34, Palmer Joshua D.34, Pillainayagam Clement34, Stover Daniel G.34, Wall Sarah34, Williams Nicole O.34, Abbasi Saqib Hussen34, Annis Sandy34, Greenland Steven34, Jones Regina34, Kasi Anup34, Rock Crosby D.34, Wulff-Burchfield Elizabeth M.34, Smits Melissa34, Weiss Matthias34, Chism David D.34, Owenby Susie34, Ang Celina34, Galsky Matthew D.34, Metzger Megan34, Berenberg Jeffrey34, Uyehara Catherine34, Fazio Alyson34, Huber Kathryn E.34, Lashley Latoya N.34, Sueyoshi Mark H.34, Patel Kanishka G.34, Riess Jonathan W.34, Borno Hala T.34, Small Eric J.34, Zhang Sylvia34, Andermann Tessa M.34, Jensen Christopher E.34, Rubinstein Samuel M.34, Wood William A.34, Ahmad Syed A.34, Grover Punita34, Jandarov Roman34, Kharofa Jordan34, Li Ningjing34, Marcum Michelle34, Sohal Davendra P. S.34, Zamulko Olga34, Abidi Maheen34, Balmaceda Nicole B.34, Bowles Daniel W.34, Geiger Christopher L.34, Markham Merry-Jennifer34, Russ Atlantis D.34, Saker Haneen34, Acoba Jared D.34, Choi Horyun34, Rho Young Soo34, Feldman Lawrence E.34, Gantt Gerald34, Hoskins Kent F.34, Khan Mahir34, Liu Li C.34, Nguyen Ryan H.34, Pasquinelli Mary M.34, Schwartz Candice34, Venepalli Neeta K.34, Vikas Praveen34, Zakharia Yousef34, Boldt Anne M.34, Fecher Leslie A.34, Su Chris34, Bijjula Ragneel34, Mavromatis Blanche H.34, Seletyn Mildred E.34, Wood Barbara R.34, Zaman Qamar U.34, Kaklamani Virginia34, Brown Alaina J.34, Charles Lawrence J.34, Cheng Alex34, Crispens Marta A.34, Croessmann Sarah34, Davis Elizabeth J.34, Ding Tan34, Duda Stephany N.34, Enriquez Kyle T.34, French Benjamin34, Gillaspie Erin A.34, Hausrath Daniel J.34, Hennessy Cassandra34, Johnson Douglas B.34, Lewis Judy T.34, Li Xuanyi (Lexi)34, Prescott Lauren S.34, Reid Sonya A.34, Saif Sara34, Shyr Yu34, Slosky David A.34, Solorzano Carmen C.34, Sun Tianyi34, Wang Lucy L.34, Yang Yuanchu James34, Aboulafia David M.34, Carducci Theresa M.34, Goldsmith Karen J.34, Van Loon Susan34, Topaloglu Umit34, Moore Joan34, Cabalona Wilhelmina D.34, Shisler Elizabeth34, Barrow McCollough Briana34, Peddi Prakash34, Rosen Lane R.34, Bilen Mehmet A.34, Castellano Cecilia A.34, Ravindranathan Deepak34, Hafez Navid34, Herbst Roy S.34, LoRusso Patricia34, Lustberg Maryam B.34, Masters Tyler34, Stratton Catherine34, Painter Corrie A.34, Peters Solange34,
Affiliation:
1. University of California Davis Comprehensive Cancer Center, Sacramento 2. University of Cincinnati Cancer Center, Cincinnati, Ohio 3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee 4. Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix 5. Mays Cancer Center at University of Texas Health San Antonio MD Anderson 6. Dana-Farber Cancer Institute and Massachusetts General Brigham, Boston 7. Hartford HealthCare Cancer Institute, Hartford, Connecticut 8. Dana-Farber Cancer Institute, Boston, Massachusetts 9. Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania 10. Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee 11. Loyola University Medical Center, Chicago, Illinois 12. Instituto Nacional de Cancerología, Mexico City, Mexico 13. Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, New York, New York 14. Brown University and Lifespan Cancer Institute, Providence, Rhode Island 15. St Elizabeth Healthcare, Edgewood, Kentucky 16. University of Michigan Rogel Cancer Center, Ann Arbor 17. Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York 18. Roswell Park Comprehensive Cancer Center, Buffalo, New York 19. Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan 20. Mount Auburn Hospital, Boston, Massachusetts 21. Penn State Cancer Institute, Hershey, Pennsylvania 22. UCSF Helen Diller Family Comprehensive Cancer Center at the University of California San Francisco 23. Moores Cancer Center, University of California San Diego 24. Loma Linda University Cancer Center, Loma Linda, California 25. Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, University of Washington, Seattle 26. Virtua Health, Marlton, New Jersey 27. University of Arkansas for Medical Sciences, Little Rock 28. Division of Internal Medicine and Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada 29. Memorial Sloan Kettering Cancer Center, New York, New York 30. New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York 31. Lifespan Cancer Institute, Providence, Rhode Island 32. Division of Hematology, Brigham and Women’s Hospital, Boston, Massachusetts 33. Division of Hematology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston 34. for the COVID-19 and Cancer Consortium
Abstract
ImportanceSystematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking.ObjectiveTo assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer.Design, Setting, and ParticipantsThis registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022.ExposureTreatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs], immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19.Main Outcomes and MeasuresMain outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up.ResultsOf 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR], 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13).Conclusions and RelevanceIn this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19–related thromboembolism in patients with cancer.
Publisher
American Medical Association (AMA)
Subject
Oncology,Cancer Research
Cited by
4 articles.
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