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Venous thromboembolism in breast cancer patients receiving cyclin‐dependent kinase inhibitors
Author(s) -
Gervaso Lorenzo,
Montero Alberto J.,
Jia Xuefei,
Khorana Alok A.
Publication year - 2020
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.14630
Subject(s) - medicine , hazard ratio , breast cancer , pulmonary embolism , proportional hazards model , venous thrombosis , confidence interval , palbociclib , deep vein , oncology , cancer , surgery , thrombosis , metastatic breast cancer
Abstract Background Venous thromboembolism ( VTE ) complicates several anticancer regimens including chemotherapy and antiangiogenic agents. Cyclin‐dependent kinase inhibitors ( CDKI s) are a new approach for hormone receptor‐positive metastatic breast cancer ( mBC ). Reported VTE rates in randomized trials range from 0.6% to 5%, but these may underestimate actual rates observed in clinical practice. Objectives Evaluate VTE rate and its association with outcomes in CDKI s patients. Patients/Methods We conducted a retrospective cohort study of consecutive mBC patients who received any of three Food and Drug Administration ( FDA) ‐approved CDKI s (palbociclib, ribociclib, abemaciclib) from January 2015 through December 2017. Venous thromboembolism including deep venous thrombosis ( DVT ), pulmonary embolism ( PE ), and visceral vein thrombosis ( VVT ) were identified by electronic medical record review. Overall survival ( OS ) and progression‐free survival ( PFS ) were estimated and evaluated for association with VTE using Cox proportional hazard regression. Results We included 424 patients, with a median age at diagnosis of 55 years. Palbociclib was the most commonly used CDKI ( n = 390, 91.8%). Venous thromboembolism during CDKI s occurred in 38 patients, 6.3% at year 1, including DVT in 52.6%, PE in 18.5%, and VVT in 15.8%. Median time to VTE was 314 days. Venous thromboembolism was associated with a trend to worse PFS and OS in multivariate analysis [ PFS hazard ratio ( HR) 1.40, 95% confidence interval (CI) 0.83‐2.38, P = .21], OS ( HR 1.70, 95% CI 0.95‐2.98, P = .076). Conclusions Venous thromboembolism rates with CDKI treatment in mBC in clinical practice are 2‐fold to 5‐fold greater than reported in registration trials and may be associated with worse outcomes.