1. Thromboembolism in Patients with Advanced Ovarian Cancer on Neo-adjuvant Chemotherapy
Waleed Alselwi1, Thomas Coventary2, Faisal Azam1
1. King Fahad specialist Hospital –Dammam, KSA.
2. North Wales Cancer centre, Betsi Cadwaladr University Hospital, UK
Background
Patients (pts) with advanced ovarian cancer (OC) on neo-adjuvant chemotherapy (NACT) are at high risk of developing venous thromboembolism (VTE). Current guidelines do not recommend thromboprophylaxis for ambulatory cancer pt on outpatient treatment. The aim of this study is to evaluate the prevalence of VTE and its impact on survival.
Methods
We performed a retrospective analysis using case notes of pts with advanced OC treated with NACT at our cancer centre between Apr2010 and May2014.
Results
A total of 58 pts were treated with NACT. VTE were identified in 17 (29%) pts comprising 6 pulmonary emboli and 11 deep vein thrombosis. Among the 17 pts who developed VTE 4(6.8%) pts had it during NACT, 5(8.6%) were diagnosed before starting NACT and 8 (13%) had it after the surgery. All pts had stage IIIC or IV OC at diagnosis. Median time of VTE from cancer diagnosis was 4 months. As per VTE risk scoring 3(5%) pts were high risk and 14(22%) were intermediate risk. 3 out of 4 patients who developed VTE during NACT were high risk(Table 1) . Median overall survival of patients with VTE was 29 months as compared to 18 months in pts without VTE. None of the pt died of VTE.
Table1: Predictive model for chemotherapy-associated VTE in ambulatory cancer patients-Risk score
Cancer-related Risk Factors
Site of cancer and tumour histotype
Number
Very high risk (stomach adenocarcinoma, pancreas adenocarcinoma) 2
High risk (lung, lymphoma, gynaecological, bladder, testicular) 1
Conclusion
VTE affected 7% pts with advanced OC on NACT. No impact on survival was noted with VTE implying that it is not a poor prognostic factor for this group of pts. Identification of high risk pts before starting NACT will help in pt selection for thromboprophylaxis.
Haematological risk factors
Number
Prechemotherapy platelet count ‡ /ll 1
Haemoglobin <10 g/dl or use of ESA growth factors
Prechemotherapy leukocyte count >11 000/ll
Patient-related Risk Factor
Patient-related risk factor
Number
Body mass index ‡35 kg/m2 1
*Low-risk category (score = 0)
*Intermediate-risk category (score = 1–2)
*High-risk category (score ≥3)