OC 64.4 - Prediction of on treatment recurrent venous thromboembolism in patients with cancer: an individual patient data meta-analysis of randomized controlled trials

Tuesday, June 27, 2023

15:30 – 15:45 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

VL

Vincent R. Lanting, MD

PhD student
Tergooi MC and Amsterdam University Medical Centers
Amsterdam, Noord-Holland, Netherlands

Co-Author(s)

FB

Floris T.M. Bosch

MD
Amsterdam University Medical Centers
Amsterdam, Noord-Holland, Netherlands
AM

Andrea Marshall

Statistician
Warwick Clinical Trials Unit
Warwick, England, United Kingdom
Gary E. Raskob, PhD

MD
University of Oklahoma Health Sciences Center, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma, United States
Oklahoma City, Oklahoma, United States
AY

Annie Young, PhD

Head of the Service
Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
Warwick, England, United Kingdom
Agnes Y.Y Lee, MD MSc (she/her/hers)

MD
University of British Columbia
Vancouver, British Columbia, Canada
MD

Marcello Di Nisio

MD
Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy
Chieti, Abruzzi, Italy
PK

Pieter W. Kamphuisen

MD
Tergooi MC and Amsterdam University Medical Centers
Hilversum, Noord-Holland, Netherlands
HB

Harry R. Büller

MD
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands
Nick van Es, MD PhD (he/him/his)

MD
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
Amsterdam, Noord-Holland, Netherlands

Background: About 5-8% of patients with cancer-associated venous thromboembolism (VTE) develop recurrence during anticoagulant treatment. Identification of high-risk patients may guide decisions about treatment intensity and duration.

Aims: To evaluate clinical predictors for on-treatment recurrent cancer-associated VTE.

Methods: Data were used from three randomized controlled trials evaluating efficacy and safety of various anticoagulants for cancer-associated VTE: Hokusai VTE Cancer, SELECT-D , and CATCH[3]. Adjudicated on-treatment recurrent VTE during 6-month follow-up was the primary outcome. Eleven candidate predictors were selected based on potential association with recurrent VTE from literature and availability in the three databases. Associations were assessed by calculating odds ratios (OR) with 95% CI in a two-stage meta-analysis using the Knapp-Hartung method, with heterogeneity assessed by I2.

Results: The combined dataset comprised 2,366 cancer patients with acute VTE. The median age was 63 years (IQR 56-70), 53% of patients were female, and 56% had metastatic disease (Table 1). Patients received dalteparin (31%), tinzaparin (19%), edoxaban (22%), rivaroxaban (9%), or warfarin (19%). Recurrent VTE during anticoagulant treatment in the 6-month follow-up occurred in 159 patients (6.7%): 81 (3.4%) with pulmonary embolism, 76 (3.2%) with DVT, and 2 (0.1%) with another localization. The median time between initial event and recurrence was 44 days (IQR 20-77). Odds ratios for the candidate predictors ranged from 0.60 to 1.65, with the strongest association observed for metastatic disease (OR 1.63; 95%-CI, 1.52-1.74) (Figure 1).

Conclusion(s): This individual patient data meta-analysis of three large trials identified metastatic disease as a strong clinical predictor for recurrent VTE in patients with cancer during anticoagulant treatment. This preliminary analysis is a first step in the development of a prediction model for recurrent VTE in cancer patients.