Thromboembolic events with cisplatin-based neoadjuvant chemotherapy for transitional cell carcinoma of urinary bladder.

Abstract

277 Background: Cancer is associated with an increased risk of venous and arterial thrombo-embolic events (TEEs), including deep vein thrombosis, pulmonary embolism, cerebrovascular accident and unstable angina/myocardial infarction. Several factors are known to influence the incidence of TEEs including chemotherapy agents, particularly cisplatin. Czaykowski et al reported 12.9% of patients receiving multiagent cisplatin based chemotherapy for transitional cell carcinoma between 1986 and 1996 developed TEE. Moore et al found that the rate of TEE in a similar cohort of patients receiving the same treatment to be 18.2% (6/33 patients). Methods: Retrospective case note review from an electronic database of patients allocated a cisplatin based neo-adjuvant chemotherapy regimen for transitional cell carcinoma of the bladder between April 2009 and April 2012. TEE was recorded as a chemotherapy related event if it occurred between the first dose of cisplatin and 4 weeks after the last administered dose. Results: 44 received treatment in the neoadjuvant setting. 11 out of 44 patients (25%) receiving neo-adjuvant chemotherapy developed TEE. 7 out of these 11 patients were male, 4 were female. 9 of the 11 TEEs (82%) in the neoadjuvant setting were arterial or peripheral arterial thrombi, including pulmonary emboli and thrombi within the aorta, left ventricle and iliac arteries. 5 of these thrombi were asymptomatic and only discovered on routine scanning. 2 out of the 11 TEEs were leg deep vein thromboses – both of which were symptomatic. 64% of TEEs occurred after the second cycle of cisplatin, the remainder after the third cycle. Conclusions: Neo-adjuvant chemotherapy is being adopted as the standard of care for patients with muscle-invasive TCC of bladder. The higher rate of TEE in our series compared to previous publications probably reflects the asymptomatic TEE being diagnosed on scans done for assessing response to chemotherapy. The significant rates of TEEs in this setting highlights the need to consider this complication as it may have a bearing on outcome from treatment, in particular delay in radical cystectomy.