Risk of arterial thromboembolism high in pancreatic cancer patients undergoing palliative chemotherapy
There appears to be an increased risk of arterial thromboembolism (aTE) in patients with pancreatic cancer undergoing palliative chemotherapy, according to a study presented at the European Society for Medical Oncology (ESMO) Asia 2018 Congress.
In a predictive model, patients who present with three or four predictors have the greatest risk for developing aTE, researchers said.
Patients had a median overall survival time of 7.7 months (range, 0.6–55.6). Of the 838 patients included in the study, 42 (5.0 percent) had aTE, and they had a worse survival outcome compared to those without aTE (5.1 vs 7.8 months; hazard ratio [HR], 1.53; 95 percent CI, 1.12–2.09). [ESMO Asia 2018, abstract 199P]
Multivariate analysis showed four independent predictors of aTE, as follows: stage IV disease, high aspartate transaminase level, and comorbidity with hypertension or atrial fibrillation.
In a concise predictive model, patients were stratified into low- (0–1 risk factor), intermediate- (2 risk factors) and high-risk (3–4 risk factors) groups. The HRs for the comparison of patients in intermediate and high-risk groups with those in the low-risk group were 4.55 (2.31–8.98) and 13.3 (5.63–31.6), respectively.
“Few studies have explored the association between pancreatic cancer and aTE,” researchers said, adding that this study sought to determine the incidence, risk factors and survival outcome of aTE in patients with pancreatic cancer.
Researchers retrospectively enrolled 838 consecutive patients who received palliative chemotherapy for unresectable or metastatic pancreatic cancer between 2010 and 2016 from four institutes in Taiwan. They analysed the clinical characteristics of patients to identify independent predictors of aTE and survival outcome.
“Further studies are needed to evaluate the performance of this predictive model,” researchers said.
According to the ESMO–ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up of pancreatic adenocarcinoma, jaundice is common (70–80 percent) in cancers involving the pancreatic head, with endoscopic stenting being the preferred procedure in unresectable patients due to its association with a lower frequency of complications. [Cochrane Database Syst Rev 2006;19:CD004200]
Patients should be given opioids when presenting with severe pain, and morphine is generally the drug of choice, the guidelines stated. In routine practice, the oral route is preferred, while parenteral or transdermal routes of administration may be considered for those who have impaired swallowing or gastrointestinal obstruction. [Cochrane Database Syst Rev 2006;19:CD004200]
“Patients should be followed at each cycle of chemotherapy for toxicity and evaluated for response to chemotherapy every 8 weeks. Clinical benefit and ultrasound may be useful tools to assess the course of disease in the metastatic setting. When performing abdominal ultrasound patients should be monitored for the presence of ascites that can indicate peritoneal disease,” according to the guidelines. [Cochrane Database Syst Rev 2006;19:CD004200]