Cancer-Associated Thrombosis on Bevacizumab: Risk of Recurrence and Bleeding When Bevacizumab Is Stopped or Continued
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patients, Inclusion Criteria, and Non-Inclusion Criteria
2.3. Surveillance and Follow-up
2.4. Endpoints
2.5. Statistical Analysis
3. Results
3.1. Population Characteristics
3.2. Primary Endpoint
3.3. Bleedings
3.4. Recurrences
3.5. Overall Survival
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Population n = 162 | Bevacizumab Continuation Group, n = 92 | Bevacizumab Discontinuation Group, n = 70 | p-Value | |
---|---|---|---|---|
Age at cancer diagnosis | 64 [55–71] | 64 [54–71] | 64 [57–1.5] | 0.82 |
Sex | ||||
Female | 96 (59%) | 58 (63%) | 38 (54%) | 0.33 |
Male | 66 (41%) | 34 (37%) | 32 (46%) | |
BMI (n = 156) | 24.6 [21–28] | 24 [20–27] | 24.6 [22–28] | 0.24 |
Performance Status | ||||
0–1 | 130/153 (85%) | 75/85 (88%) | 55/68 (81%) | 0.18 |
2–3 | 23 (15%) | 10 (12%) | 13 (19%) | 0.26 |
Renal failure (eGFR < 60 mL/mn) | 27/144 (19%) | 15/92 (16%) | 12/63 (19%) | >0.99 |
Anemia (Hb < 100 g/L) | 11/153 5 (7%) | 4/86 (5%) | 7/67 (10%) | 0.21 |
Thrombocytosis (>300 G/L) | 38/148 (26%) | 19/85 (22%) | 19/63 (30%) | 0.34 |
Antiaplatelet therapy | 17 (11%) | 11 (12%) | 6 (9%) | 0.61 |
Cancer type | ||||
Colorectal | 78 (48%) | 39 (42%) | 39 (56%) | 0.11 |
Ovarian, endometrial | 28 (17%) | 20 (21%) | 8 (11%) | 0.10 |
Breast | 15 (9%) | 10 (11%) | 5 (7%) | 0.59 |
Lung | 18 (11%) | 13 (14%) | 5 (7%) | 0.21 |
Central nervous system | 17 (11%) | 7 (8%) | 10 (14%) | 0.20 |
Others | 6 (4%) | 3 (3%) | 3 (4%) | 0.99 |
Histological subtype | ||||
Adénocarcinome | 119 (73%) | 67 (73%) | 52 (74%) | 0.86 |
Current treatment line | ||||
1st line | 74/152 (49%) | 44/85 (52%) | 30/67 (45%) | 0.43 |
2nd line | 50 (33%) | 24 (28%) | 26 (39%) | 0.22 |
3rd line | 28 (18%) | 17 (20%) | 11 (16%) | 0.68 |
Platinum salt treatment | 62 (38%) | 36 (39%) | 26 (37%) | 0.87 |
Metastatic disease | 123/146 (84%) | 77/85 (91%) | 46/61 (75%) | 0.02 |
Metastases | ||||
Cerebral | 9 (6%) | 6 (6%) | 3 (4%) | 0.73 |
Hepatic | 57 (35%) | 29 (32%) | 28 (40%) | 0.32 |
Population n = 162 | Bevacizumab Continuation Group, n = 92 | Bevacizumab Discontinuation Group, n = 70 | p-Value | |
---|---|---|---|---|
CAT localization | ||||
DVT | 58 (36%) | 34 (37%) | 24 (34%) | 0.74 |
PE | 81 (50%) | 48 (52%) | 33 (47%) | 0.63 |
DVT and PE | 23 (14%) | 10 (11%) | 13 (19%) | 0.18 |
Most proximal obstruction of PE | ||||
Segmental or more proximal | 79/97 (81%) | 46/54 (85%) | 33/43 (76%) | 0.31 |
Subsegmental | 18 (19%) | 8 (15%) | 10 (23%) | |
Unilateral | 55/98 (56%) | 32/56 (57%) | 23/42 (55%) | 0.84 |
Bilateral | 43 (44%) | 24 (43%) | 19 (45%) | |
Discovery mode Clinically suspected | 82/160 (51%) | 44/91 (48%) | 38/69 (55%) | 0.43 |
Incidental asymptomatic | 65 (41%) | 42 (46%) | 23 (33%) | 0.11 |
Incidental symptomatic | 13 (8%) | 5 (6%) | 8 (12%) | 0.24 |
Time between CAT and first inclusion (days) | 3080 [1947–4089] | 3239 [2931–3554] | 2528 [2313–3505] | 0.03 |
LMWH therapy | 152 (94%) | 87(95%) | 65 (93%) | 0.75 |
LMWH discontinuation during the follow-up | 52/145 (36%) | 31/79(39%) | 21/66 (32%) | 0.23 |
Time between bevacizumab initiation and CAT (days) | 79 [39–154] | 77 [41–141] | 84 [35–173] | 0.55 |
Bevacizumab posology at CAT diagnosis (mg/kg) (n = 135) | 7.5 [5–10] | 7.5 [5–10] | 5 [5–10] | 0.20 |
Other risk factor of CAT | 37 (23%) | 18 (20%) | 19 (21%) | 0.26 |
Response to oncologic treatment Response | 40/154 (26%) | 27/87 (31%) | 13/67 (19%) | 0.14 |
Stability | 76 (49%) | 50 (57%) | 26 (38%) | 0.02 |
Progression | 38 (25%) | 10 (11%) | 28 (42%) | 0.0001 |
Population n = 162 | Bevacizumab Continuation Group, n = 92 | Bevacizumab Discontinuation Group, n = 70 | |
---|---|---|---|
CAT recurrence or bleeding | 48 (30%) | 27 (29%) | 21 (30%) |
Recurrence | 21 (13%) | 13 (14%) | 8 (11%) |
Bleeding | 27 (17%) | 14 (15%) | 13 (19%) |
Major bleeding | 10 (6%) | 6 (7%) | 4 (6%) |
Clinically relevant non major bleeding | 17 (11%) | 8 (8%) | 9 (13%) |
Population n = 162 | Bevacizumab Continuation Group, n = 92 | Bevacizumab Discontinuation Group, n = 70 | |
---|---|---|---|
Death | 139 (90%) | 80 (87%) | 59 (82%) |
Cancer related deaths | 115 (83%) | 65 (81%) | 50 (85%) |
Fatal bleeding | 4 (3%) | 3 (4%) | 1 (2%) |
Other cause of death | 12 (9%) | 6 (8%) | 6 (10%) |
Unknown cause of death | 4 (3%) | 6 (8%) | 2 (3%) |
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Mayenga, M.; Falvo, N.; Mahé, I.; Jannot, A.-S.; Gazeau, B.; Meyer, G.; Gendron, N.; Sanchez, O.; Djennaoui, S.; Planquette, B. Cancer-Associated Thrombosis on Bevacizumab: Risk of Recurrence and Bleeding When Bevacizumab Is Stopped or Continued. Cancers 2023, 15, 3893. https://doi.org/10.3390/cancers15153893
Mayenga M, Falvo N, Mahé I, Jannot A-S, Gazeau B, Meyer G, Gendron N, Sanchez O, Djennaoui S, Planquette B. Cancer-Associated Thrombosis on Bevacizumab: Risk of Recurrence and Bleeding When Bevacizumab Is Stopped or Continued. Cancers. 2023; 15(15):3893. https://doi.org/10.3390/cancers15153893
Chicago/Turabian StyleMayenga, Marie, Nicolas Falvo, Isabelle Mahé, Anne-Sophie Jannot, Benoit Gazeau, Guy Meyer, Nicolas Gendron, Olivier Sanchez, Sadji Djennaoui, and Benjamin Planquette. 2023. "Cancer-Associated Thrombosis on Bevacizumab: Risk of Recurrence and Bleeding When Bevacizumab Is Stopped or Continued" Cancers 15, no. 15: 3893. https://doi.org/10.3390/cancers15153893