More Lines of Chemotherapy Linked to Higher Risk of VTE in Ovarian Cancer

Heavily treated patients with ovarian cancer may benefit from thromboprophylaxis, according to a presentation at the 2023 SGO Annual Meeting on Women’s Cancer.

In a single-center study, researchers found that the risk of venous thromboembolism (VTE) increased as patients received more lines of chemotherapy. 

VTE did not affect overall survival in these patients, but it did have a negative impact on quality of life, said study presenter Erika J. Lampert, MD, of the Cleveland Clinic in Ohio.

The study included 345 patients who received second-line or later therapy for recurrent, advanced epithelial ovarian cancer at the Cleveland Clinic during 2007-2020.

The rate of VTE was 22% in this cohort. Comparing the patients with VTE (n=22) and without it (n=268) revealed no significant differences in age, race, body mass index, or smoking history between the groups. However, the patients with VTE had received more lines of chemotherapy than the patients without VTE — a median of 5 lines and 4 lines, respectively (P =.012).

In a multivariate analysis, the only significant predictor of VTE was the number of prior lines of chemotherapy (odds ratio, 1.14; 95% CI, 1.02-1.28; P =.026). Dr Lampert noted that, although most patients with VTE had a Khorana score of 2 or higher, Khorana score was not associated with VTE risk in these patients.

In the VTE cohort, 53% of patients had deep vein thrombosis, 40% had a pulmonary embolism, and 7% had both. Most thrombotic events were diagnosed at routine imaging (41%) or an emergency department visit (31.5%). At the time of VTE, most patients were receiving chemotherapy (72.7%), and few had undergone surgery in the previous 30 days (3.9%).

Patients with VTE did not have worse overall survival than patients without VTE (P =.29), although 1 patient died of VTE. VTE led to hospitalization in more than half of patients (54.5%), and some experienced a bleeding complication on anticoagulant therapy (11.7%). 

“In conclusion, 1 in 5 patients with recurrent ovarian cancer developed a VTE. This is higher than previous estimates in the literature and likely reflects the heavily treated nature of our cohort,” Dr Lampert said. “Risk of VTE was higher while receiving chemotherapy and with increasing lines of chemotherapy. This suggests that our heavily treated population on chemotherapy may benefit from prophylaxis. However, a prospective study of VTE risk in a heavily treated, recurrent ovarian cancer population is certainly warranted.”

Disclosures: Dr Lampert reported having no conflicts of interest. 

Reference

Lampert EJ, Tewari S, Yao M, et al. Higher incidence of venous thromboembolism associated with increasing lines of chemotherapy in heavily treated ovarian cancer patients. SGO 2023. March 25-28, 2023.