Lung Cancer 86 (2014) 73–77 Contents lists available at ScienceDirect Lung Cancer jou rn al hom epage: www.elsevier.com/locate/lungcan Retrospective evaluation of thromboembolic events in patients with non-small cell lung cancer treated with platinum-based chemotherapy Wouter W. Mellema, Dorien van der Hoek, Pieter E. Postmus, Egbert F. Smit ∗ Department of Pulmonary Diseases, VU University Medical Center, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands a r t i c l e i n f o Article history: Received 6 January 2014 Received in revised form 23 July 2014 Accepted 25 July 2014 Keywords: Non-small cell lung carcinoma Platinum chemotherapy Cisplatin Carboplatin Thrombosis Venous thromboembolic event (VTE) Arterial thromboembolic event (ATE) a b s t r a c t Objectives: Thromboembolic events (TE) are common in patients with cancer and are potentially life- threatening. In lung cancer, little is known about thrombosis during chemotherapy treatment. The aim of this study was to describe the incidence of TE in patients with non-small cell lung cancer (NSCLC), occurring during treatment with platinum-based chemotherapy. Methods: We retrospectively selected patients with NSCLC treated with platinum-based chemotherapy at the VU University Medical Center Amsterdam between 2000 and 2012. Patients who underwent recent surgery were excluded. All TE were included that occurred from start of chemotherapy treatment until 30 days after last administration. Results: Among 784 included patients, 63 (8.0%) patients had 69 TE during treatment. Forty-five venous TE (VTE) and 24 arterial TE (ATE). Six patients had multiple events within treatment period, 3 of which had simultaneous ATE and VTE. In total, 613 patients were treated with cisplatin, 119 patients received carboplatin and 52 patients received both in first- or second-line treatment. In 8% (55/665) of the patients exposed to cisplatin a TE had occurred vs. 5% (8/171) in patients exposed to carboplatin (p = 0.42). The majority of TE occurred in the first 2 cycles (70%). History of TE was related to occurrence of TE during chemotherapy (p < 0.01). Median PFS was similar in patients with and without TE (6.2 vs. 7.2 months, respectively; p = 0.10). Median OS was significantly shorter in patients with TE (9.5 vs. 12.9 months, respectively; p = 0.03). Conclusion: In our series, both ATE and VTE were a common finding during chemotherapy. TE was a poor prognostic factor. No difference in TE incidence was found between patients treated with cisplatin or carboplatin. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Thromboembolic events (TE) in cancer patients are a well described phenomenon since Trousseau established a relationship between cancer and thrombosis in 1865 [1]. Both venous and arterial thromboembolic events (VTE and ATE) in patients may be a first sign of cancer becoming symptomatic in the near future [2–5]. Between TE and cancer there is a two-way relationship. In cancer patients who develop VTE at time of diagnosis, a worse prognosis and a more advanced stage has been reported, suggest- ing that TE is a marker of more aggressive disease [6]. On the other hand, patients with known malignancy, have an increased risk on ∗ Corresponding author. Tel.: +31 020 444 4349; fax: +31 020 444 4328. E-mail address: ef.smit@vumc.nl (E.F. Smit). developing TE [7,8]. An overall 7-fold increased risk of VTE was reported in patients with malignancy compared to those without. In lung cancer patients a 22-fold risk increase was observed in one study [9]. Reported incidences of TE in cancer patients are as high as 20% [10]. This has a major influence on the patients’ prognosis and increase morbidity rates, especially patients experiencing a pulmonary embolism or myocardial infarction [11]. It has been reported that cisplatin-based chemotherapy increases the risk of VTE [12]. The pathophysiology of cisplatin- related TE is poorly understood [13]. In lung cancer, platinum-based chemotherapy is standard as first-line treatment. Unfortunately, previous studies focussed on treatment with cisplatin only, thereby leaving the occurrence of TE in patients treated with carboplatin unaddressed. Carboplatin is believed to be the safer choice, with less renal toxicity and nausea/vomiting, but the incidence of TE during treatment with carboplatin is unknown [14]. The aim of our http://dx.doi.org/10.1016/j.lungcan.2014.07.017 0169-5002/© 2014 Elsevier Ireland Ltd. All rights reserved.