Improved survival of advanced melanoma patients receiving immunotherapy with concomitant antithrombotic therapy - A multicenter study on 2419 patients from the prospective skin cancer registry ADOReg.

IF 7.6 1区 医学 Q1 ONCOLOGY
European Journal of Cancer Pub Date : 2025-01-01 Epub Date: 2024-11-30 DOI:10.1016/j.ejca.2024.115159
Julian Kött, Tim Zell, Noah Zimmermann, Alessandra Rünger, Daniel J Smit, Finn Abeck, Glenn Geidel, Inga Hansen-Abeck, Isabel Heidrich, Michael Weichenthal, Selma Ugurel, Ulrike Leiter, Carola Berking, Ralf Gutzmer, Dirk Schadendorf, Lisa Zimmer, Elisabeth Livingstone, Imke von Wasielewski, Peter Mohr, Friedegund Meier, Sebastian Haferkamp, Konstantin Drexler, Rudolf Herbst, Ivonne Kellner, Jochen Utikal, Sebastian A Wohlfeil, Claudia Pföhler, Leonie Adam, Patrick Terheyden, Jens Ulrich, Frank Meiss, Monica Möbes, Julia Welzel, Bastian Schilling, Fabian Ziller, Martin Kaatz, Alexander Kreuter, Anca Sindrilaru, Edgar Dippel, Michael Sachse, Carsten Weishaupt, Svea Hüning, Lucie Heinzerling, Carmen Loquai, Gaston Schley, Thilo Gambichler, Harald Löffler, Stephan Grabbe, Erwin Schultz, Nina Devereux, Jesscia C Hassel, Jan-Ch Simon, Ulrike Raap, Chalid Assaf, Claus-Detlev Klemke, Cord Sunderkötter, Silke C Hofmann, Saskia Wenk, Michael Tronnier, Silke Thies, Markus V Heppt, Alexander Eggermont, Hans-Joachim Schulze, Christos C Zouboulis, Thomas Tüting, Alexander T Bauer, Stefan W Schneider, Christoffer Gebhardt
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引用次数: 0

Abstract

Background: Cancer immunotherapy has revolutionized melanoma treatment, but the high number of non-responders still emphasizes the need for improvement of therapy. One potential avenue for enhancing anti-tumor treatment is through the modulation of coagulation and platelet activity. Both have been found to play an important role in the tumor microenvironment, tumor growth and metastasis. Preclinical studies indicate a beneficial effect, clinical data has been inconsistent.

Methods: We examined a cohort of advanced, non-resectable melanoma patients (n = 2419) derived from the German prospective multicenter skin cancer registry ADOReg, who were treated with immune checkpoint inhibitors (ICI). The patients were classified based on whether it was documented that they received platelet aggregation inhibition (PAI) (n = 137) (acetylsalicylic acid (ASA) or clopidogrel), anticoagulation (AC) (n = 185) (direct oral anticoagulation (DOAC), phenprocoumon, heparins) at the start of ICI or no antithrombotic medication (n = 2097) at any point during ICI treatment. The study endpoints were best overall response (BOR), progression-free survival (PFS) and overall survival (OS).

Results: A significantly improved PFS was observed in patients documented to receive ASA (15.1 vs 6.4 months, HR 0.67, 95 % CI: 0.5 to 0.88, p = 0.0047) as well as in patients to receive AC (15.1 vs. 6.4 months, HR 0.7, 95 % CI: 0.53 to 0.91, p = 0.01) compared to patients for whom no antithrombotic medication was documented. Multivariate analysis of OS showed significant risk reduction in patients who received DOAC (HR 0.68, 95 % CI: 0.49 to 0.92, p = 0.0170) or phenprocoumon (HR: 0.44, 95 % CI: 0.19 to 0.85, p = 0.0301).

Conclusion: Our study indicates a positive prognostic effect of anticoagulant and antiplatelet concomitant medication in melanoma patients receiving ICI. Further studies are needed to confrim the cancer-related benefit of adding anticoagulation or platelet inhibition to ICI treatment.

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来源期刊
European Journal of Cancer
European Journal of Cancer 医学-肿瘤学
CiteScore
11.50
自引率
4.80%
发文量
953
审稿时长
23 days
期刊介绍: The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.
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