Alberto Carmona-Bayonas1, David Gómez2, Eva Martínez de Castro3, Pedro Pérez Segura4, José Muñoz Langa5, Paula Jimenez-Fonseca6, Manuel Sánchez Cánovas1, Laura Ortega Moran7, Ignacio García Escobar8, Ana Belén Rupérez Blanco9, Isaura Fernández Pérez10, Purificación Martínez de Prado11, Rut Porta I Balanyà12, Teresa Quintanar Verduguez13, Álvaro Rodríguez-Lescure13, Andrés Muñoz14. 1. Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain. 2. Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, UPV/EHU, Oviedo, Spain. 3. Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. 4. Medical Oncology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain. 5. Medical Oncology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain. 6. Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain. 7. Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain. 8. Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. 9. Medical Oncology Department, Hospital Universitario Fundation Jiménez Díaz, Madrid, Spain. 10. Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. 11. Medical Oncology Department, Hospital de Basurto, Bilbao, Spain. 12. Medical Oncology Department, Hospital Universitari Dr Josep Trueta, Institut Català d'Oncologia, Girona, Spain and Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Spain. 13. Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain. 14. Medical Oncology Department, Hospital Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain. Electronic address: ajmunoz.hgugm@salud.madrid.org.
Abstract
BACKGROUND: The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. METHOD: TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. RESULTS: Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. CONCLUSION: CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.
BACKGROUND: The ever-growing complexity of cancer-associated thrombosis (CAT), with new antineoplastic drugs and anticoagulants, distinctive characteristics, and decisions with low levels of evidence, justifies this registry. METHOD: TESEO is a prospective registry promoted by the Spanish Society of Medical Oncology to which 34 centers contribute cases. It seeks to provide an epidemiological description of CAT in Spain. RESULTS:Participants (N=939) with CAT diagnosed between July 2018 and December 2019 were recruited. Most subjects had advanced colon (21.4%), non-small cell lung (19.2%), and breast (11.1%) cancers, treated with dual-agent chemotherapy (28.4%), monochemotherapy (14.4%), or immune checkpoint inhibitors (3.6%). Half (51%) were unsuspected events, albeit only 57.1% were truly asymptomatic. Pulmonary embolism (PE) was recorded in 571 (58.3%); in 120/571 (21.0%), there was a concurrent deep venous thromboembolism (VTE). Most initially received low molecular weight heparin (89.7%). Suspected and unsuspected VTE had an OS rate of 9.9 (95% CI, 7.3-non-computable) and 14.4 months (95% CI, 12.6-non-computable) (p=0.00038). Six-month survival was 80.9%, 55.9%, and 55.5% for unsuspected PE, unsuspected PE admitted for another reason, and suspected PE, respectively (p<0.0001). The 12-month cumulative incidence of venous rethrombosis was 7.1% (95% CI, 4.7-10.2) in stage IV vs 3.0% (95% CI, 0.9-7.1) in stages I-III. The 12-month cumulative incidence of major/clinically relevant bleeding was 9.6% (95% CI, 6.1-14.0) in the presence of risk factors. CONCLUSION: CAT continues to be a relevant problem in the era of immunotherapy and targeted therapies. The initial TESEO data highlight the evolution of CAT, with new agents and thrombotic risk factors.
Authors: David Zaragoza-Huesca; Pedro Garrido-Rodríguez; Paula Jiménez-Fonseca; Eva Martínez de Castro; Manuel Sánchez-Cánovas; Laura Visa; Ana Custodio; Ana Fernández-Montes; Julia Peñas-Martínez; Patricia Morales Del Burgo; Javier Gallego; Ginés Luengo-Gil; Vicente Vicente; Irene Martínez-Martínez; Alberto Carmona-Bayonas Journal: Biomedicines Date: 2022-01-11