Thromboembolic Event Risk With Cisplatin vs Carboplatin in Lung Cancer

In the first study of its kind, researchers compared the risk for thromboembolic events (TEEs) in patients with lung cancer who were treated with either cisplatin or carboplatin.

Findings from the analysis, published in PLoS One, demonstrated that the high incidence of TEEs observed, including arterial thrombosis, is not specific to the use of cisplatin alone, but is associated with the use of platinum-based chemotherapy agents in general.

A total of 415 patients with lung cancer who were treated with either cisplatin (n=98) or carboplatin (n=317) at the Wilmot Cancer Center at the University of Rochester in New York were enrolled in the study. Patient characteristics were compiled by reviewing electronic medical records on exposure (cisplatin or carboplatin) and outcome (occurrence of any TEEs between the time of the first cisplatin or carboplatin dose and 4 weeks following the last dose).

TEEs were defined as deep venous thrombosis or arterial thrombosis that includes pulmonary embolism, unstable angina/myocardial infarction, and cerebrovascular accident. The proportion of incident TEEs between the cisplatin and carboplatin arms was compared using a Fisher’s exact test. Multiple logistic regression analysis was used to assess the risk for TEEs linked to cisplatin compared with carboplatin.

Of the 415 patients enrolled in the study, 47 (11.3%) experienced a new TEE during platinum-based chemotherapy or within 4 weeks after receiving the last treatment. In the carboplatin arm, 10.9% (33 of 302) of evaluable patients developed treatment-related TEEs compared with 14.7% (14 of 95) of patients in the cisplatin arm.

In a univariate analysis, no significant difference was reported in the risk for the development of TEEs between the two groups (odds ratio [OR], 0.71; 95% CI, 0.36-1.39; P =.32). In a similar fashion, in a multivariate logistic regression model, no significant difference in risk for TEEs was reported between the treatment arms (OR, 0.72; 95% CI, 0.36-1.47; P =.37). Overall, however, 15.2% of carboplatin-associated TEEs were arterial thromboses compared with no cisplatin-associated arterial thromboses.

The researchers concluded that the potential use of prophylactic anticoagulation in all platinum-treated patients with lung cancer merits further investigation. In addition, identifying high-risk groups and developing optimal strategies to reduce the risk for TEEs could benefit this patient population.

Reference

Kim ES, Baran AM, Mondo EL, et al. Risk of thromboembolism in cisplatin versus carboplatin-treated patients with lung cancer. PLoS One. 2017;12(12):e0189410