A retrospective cohort study found that 25% of patients receiving neoadjuvant chemotherapy followed by cystectomy for bladder cancer experienced a venous thromboembolism (VTE), and that 72% of VTEs were detected while being treated with neoadjuvant chemotherapy. Currently, Shady Garas, MD, division of urology, University of Ottawa, Ottawa, Ontario, Canada, and colleagues, wrote, “there is limited evidence to inform thromboprophylaxis for patients receiving neoadjuvant chemotherapy prior to surgery in bladder cancer.”

To determine the incidence of VTE in patients receiving neoadjuvant chemotherapy and cystectomy, Dr Garas and colleagues conducted a retrospective cohort study. The study included 181 patients at The Ottawa Hospital who received treatment between January 2016 and August 2020. Of all the patients, 123 had muscle-invasive disease, and 72 received neoadjuvant chemotherapy and cystectomy, while 109 underwent cystectomy alone.

Data on demographic information, chemotherapy, operative characteristics, VTE and bleeding outcomes were collected at the initiation of treatment to 90 days post-cystectomy. For patients receiving neoadjuvant chemotherapy, a Khorana score was also calculated. The primary end point was incidence of VTE from the time the patients started on treatment with neoadjuvant chemotherapy until 90 days after the cystectomy.

Of the patients who received neoadjuvant chemotherapy and radical cystectomy, 18 (25%) developed a VTE between the start of chemotherapy and 90 days post-cystectomy, compared to 9 who received cystectomy alone (P = .0002). Of those patients, 13 (72%) had the VTE occur while receiving chemotherapy, 3 had a VTE postoperatively while in the hospital, and 2 had a VTE after the cystectomy and discharge within 90 days post-surgery. There was 1 patient who experienced a major bleeding event during neoadjuvant chemotherapy.

In a multivariable analysis, treatment with neoadjuvant chemotherapy was the only factor associated with a significantly increased risk of VTE (Relative risk [RR], 3.05; 95% confidence interval [CI], 1.16 to 8.02; P = .02). There was not an association found between higher Khorana score and increased risk of VTE in patients receiving neoadjuvant chemotherapy (RR, 0.33; 95% CI, 0.08 to 1.28; P = .11).

Dr Garas, et al, concluded that “patients receiving neoadjuvant chemotherapy and radical cystectomy are at a very high-risk of VTE” and added that “prospective studies that assess the benefits and harms of pharmacologic thromboprophylaxis in this population are needed.”

Source:

Garas SN, McAlpine K, Ross J, et al. Venous thromboembolism risk in patients receiving neoadjuvant chemotherapy for bladder cancer. Urol Oncol. 2022;40(8):381.e1-381.e7. doi:10.1016/j.urolonc.2022.04.006