Incidence of cardiovascular adverse events (AEs) in resected non-small cell lung cancer (NSCLC) patients receiving adjuvant platinum-based chemotherapy: a single institution experience from Wythenshawe Hospital, Manchester, UK

Abstract

Introduction: Adjuvant platinum-based chemotherapy is the standard of care for patients with resected stage 1b–3 NSCLC but platinum can cause significant cardiovascular (CV) AEs. Lung cancer patients often have pre-existing CV co-morbidities which can preclude them from receiving adjuvant treatment. Even with careful patient selection, they may develop cardiovascular morbidity during adjuvant chemotherapy. This audit was undertaken to identify a specific population who may benefit from cardio-oncological input. Methods: We conducted a retrospective analysis of patients treated with adjuvant chemotherapy at Wythenshawe Hospital, Manchester between January and December 2018 to determine the incidence of CV events (CVE). Data was collected via electronic patient records and chemotherapy prescribing software. Microsoft Excel and SPSS were used to categorise patients into CV/non-CV event groups. Patient demographics including age, gender, BMI, comorbidities, smoking, family history, stage and chemotherapy were statistically analysed by logistic regression and Fisher’s exact tests. Any cardiac or vascular event requiring intervention or hospitalisation including venous-thromboembolism (VTE) was recorded. Results: A total of 99 patients were identified. 19% of patients experienced a CVE, 11% of which were fatal. 42% of CVEs were VTEs, 21% acute AF, 8% acute coronary syndrome and 8% CVA/TIA. Half of the patients received Cisplatin/Vinorelbine and half Carboplatin/ Vinorelbine. Patients with stage 3 disease had a statistically significant increased risk of experiencing a CVE but no other patient subgroup was found to be at specific risk. Conclusion: Patients with stage 3 disease had a higher incidence of CVEs, possibly due to selective bias for chemotherapy despite having high comorbidity risks. The incidence of CVEs was 19%, higher than those of adjuvant trials but a large proportion of CVEs were VTEs. Implementation of early cardio-oncological input was recommended and continuation of VTE prophylaxis during chemotherapy is being considered.