Cisplatin-Based Combinations-Associated Vasculopathy - A Disproportionality Analysis of Real-World Pharmacovigilance Data.

Abstract

Introduction: Cisplatin, a platinum-based antineoplastic agent belonging to the alkylating class, is one of the most widely used chemotherapeutic agents in the treatment of solid tumors and hematologic malignancies. Cisplatin works by forming covalent bonds in DNA, resulting in cell cycle arrest, inadequate repair, and ultimately, apoptotic or non-apoptotic cell death. Despite its efficacy, cisplatin is known to be highly toxic, showing nephrological, Gastrointestinal (GI), and hepatotoxicity, but there is limited data on its association with adverse vascular events. Hence, we aimed to investigate the potential risk of drug-related adverse vascular events associated with four cisplatin-based combination therapies using the FDA Adverse Events Reporting System (FAERS).

Methods: We used the FDA Adverse Events Reporting System (FAERS) database to look for reported Adverse Events (AEs) for cisplatin-based combinations. In the current study, a case/non-case disproportionality analysis has been performed using the Reporting Odds Ratio (ROR) to investigate whether there is a signal for a potentially increased risk of drug-related vascular AE using the 2016-2020 FAERS datasets. To look for all vascular AEs, we included peripheral vascular events, cerebrovascular events, coronary artery-related events, venothromboembolic events, and other arterial events. "Cases" were defined as patients treated with cisplatin and any one of etoposide, gemcitabine, paclitaxel or docetaxel, and 5-fluorouracil or capecitabine, and have reported a composite event. Hence, cases were divided into 4 groups. Reporting Odds Ratio (ROR) and Information Component (IC) were derived to look for signals for these AEs being significant when compared to non-cases. All data processing and statistical analyses were performed using R 4.2.1.

Results: Between 2016 and 2020, 23,513 AEs were reported for patients who used cisplatinbased combinations, and 6,952,691 AEs in patients who did not. Baseline characteristics, including age, sex, and geographic distribution, were also reported. Looking at ROR and IC, all 4 groups showed statistically significant vasculopathies reported for cisplatin-based combinations, except for cisplatin and paclitaxel/docetaxel where there was a trend in ROR, but it did not reach statistical significance. It also gave the least signal for associated vasculopathy, while cisplatin and gemcitabine gave the highest signal with both ROR and IC for associated vasculopathy.

Conclusion: Overall, these increased vasculopathies related to the use of cisplatin-based combinations can be related to the increased pro-thrombotic state in these patients. The results of this study highlight the need for caution when using cisplatin-based chemotherapy and the importance of monitoring patients for thrombotic events and other vasculopathies. Patient-specific factors, such as the type and stage of cancer, should be considered when determining the best treatment option and managing the risk of vascular complications.