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Thromboembolism in patients with advanced gastroesophageal cancer treated with anthracycline, platinum, and fluoropyrimidine combination chemotherapy: A report from the UK national cancer research institute upper gastrointestinal clinical studies group
Journal of Clinical Oncology, 08/10/09

Starling N et al. - This analysis has prospectively quantified the incidence/pattern of thromboembolic events (TEs) among patients with advanced gastroesophageal cancer who were treated with 4 triplet regimens, has demonstrated a differential thrombogenic effect according to platinum use, and has noted a poorer outcome associated with TE during treatment.

Methods

Aim was to investigate the prevalence of and outcomes related to TEs in pts with advanced gastroesophageal cancer who are undergoing chemotherapy
964 pts recruited between 2000-2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy
Regimens were:
- Epirubicin (E), cisplatin (C), fluorouracil (F; ECF)
- E, C, capecitabine (X; ECX)
- E, F, oxaliplatin (O; EOF); and
- EOX
Continuously infused F was administered via a central venous access device (CVAD) with 1 mg of warfarin for thromboprophylaxis
Principal outcome: incidence of TEs (venous and arterial) according to chemotherapy, associated with CVADs and TE-related prognoses

Results

Incidences of any, of venous, and of arterial TEs among 964 treated pts were 12.1%, 10.1%, and 2.2% respectively
There were fewer TEs in the O vs cisplatin groups
C was identified as a risk factor for TE in multivariate analysis
No difference in the incidence of TEs for the F group vs capecitabine groups
Incidence of CVAD-related thrombosis was 7.0%
Overall survival was worse for pts who experienced TEs vs no TEs

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