Incidence of thromboembolic events in testicular cancer patients receiving cisplatin (TESTCIS study)

Abstract

Introduction

Despite the increased incidence of testicular cancer in men aged 15 to 35, patients with this neoplasm have a high five-year survival rate thanks to chemotherapy. However, cisplatin, a drug used in the standard treatment for testicular cancer, seems to be associated with an increased incidence of thromboembolic events. The TESTCIS study aimed to describe the incidence of thromboembolic events in testicular cancer patients receiving cisplatin, identify the risk factors for thromboembolism, and determine the proportion of patients whose chemotherapy regimens had to be modified after a thromboembolic event to assess the appropriateness of concomitant thromboprophylaxis with cisplatin use.

Methods

TESTCIS is a descriptive, longitudinal and retrospective study that was carried out at four hospitals in the Chaudière-Appalaches administrative region of the province of Quebec. Patients included in the study must have initiated and completed cisplatin-based chemotherapy between January 1, 2012 and November 30, 2023. Bivariate logistic regression was used to explore a relationship between the identified variables and a thromboembolic event.

Results

In the study, 23 out of 56 patients (41.1%) presented with at least one thromboembolic event. For 19 of these 56 patients (33.9%) the thromboembolic event was major, i.e., a pulmonary embolism, deep vein thrombosis, arterial thrombosis or cerebral venous thrombosis. The majority of these thromboembolic events (84.4%) occurred while the patients were on chemotherapy. Among the characteristics studied, disease recurrence (p = 0.03735) and a Khorana score of 2 (p = 0.01124) had a statistically significant relationship with the occurrence of a thromboembolic event. The chemotherapy regimen was changed for three patients (5.4%) due to a thromboembolic event. Overall, 7 out of 56 patients (12.5%) received thromboprophylaxis, and three of these patients nevertheless experienced a thromboembolic event. Five patients (8.9%) experienced bleeding, but only one of these five patients (who was not on anticoagulant therapy) experienced a major bleed.

Conclusion

The observed occurrence of thromboembolic events in 41.1% of patients in the TESTCIS study illustrates a need for further studies and discussions to identify true benefits of thromboprophylaxis for patients with testicular cancer receiving a cisplatin-based protocol. Based on our observations, we believe that recurrent testicular cancer and a Khorana score of 2 or more at initial assessment should be considered exploratory findings that warrant confirmation in larger prospective studies. Careful attention should also be paid to patients with superficial venous thrombosis, as this condition may put the patient at risk of a subsequent major thromboembolic event. The efficacy and safety of thromboprophylaxis in this patient population should be evaluated further in a post-intervention study.