title: Prospective evaluation of major vascular events in patients with nonsmall cell lung carcinoma treated with cisplatin and gemcitabine.
abstract: BACKGROUND
  Cancer and cisplatin-based chemotherapy both are well recognized risk factors for coagulation disorders and thrombosis. However, vascular events (VEs) seldom are considered adverse effects of treatment and may not even be taken into account in reports of chemotherapy trials.
  
  
  METHODS
  VEs were recorded prospectively in a population of patients with nonsmall-cell lung carcinoma (NSCLC) who were treated consecutively with cisplatin and gemcitabine using a diagnostic flow chart based on a thorough clinical examination, hematologic and coagulative parameters, and imaging assessments when appropriate.
  
  
  RESULTS
  From January, 2000 to January 2003, 108 patients with Stage III-IV NSCLC underwent chemotherapy and were evaluated. Overall, 22 VEs occurred in 19 patients (17.6%; 95% confidence interval [95% CI], 10.3-24.8%), including 10 arterial VEs (2 myocardial infarctions, 7 lower limb arterial thrombosis, and 1 ischemic stroke) and 12 venous VEs (3 catheter-related upper limb VEs, 6 venous thrombosis of the lower limb, and 3 pulmonary embolisms). The cumulative proportion of VEs at 1 year after the start of chemotherapy was 22.0% (95% CI, 12.7-31.3%). Four patients died due to the VE (overall mortality, 3.7%), and 3 patients needed surgical revascularization. In the other patients, conservative medical treatment was effective. Baseline patient-related and disease-related characteristics of the patients with VEs did not differ significantly from the characteristics of patients without VE; liver and brain metastases were more frequent in patients with VE, although the difference did not reach statistical significance. Response rates were similar in the two groups. A double VE was detected in three patients who were given further chemotherapy after resolution of the first event.
  
  
  CONCLUSIONS
  VEs were a common finding in chemotherapy-treated NSCLC patients. Chemotherapy itself seem to be a powerful risk factor for VE. Strategies to predict the occurrence of VEs should be developed to spare this life-threatening toxicity.
authors.affiliation: Department of Medical Oncology, S. Croce General Hospital, Cuneo, Italy. gnumico@libero.it
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Ornella
authors.initials: O
authors.lastname: Garrone
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Dongiovanni
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestris
authors.forename: Ida
authors.initials: I
authors.lastname: Colantonio
authors.forename: Gianna
authors.initials: G
authors.lastname: Di Costanzo
authors.forename: Cristina
authors.initials: C
authors.lastname: Granetto
authors.forename: Marcella
authors.initials: M
authors.lastname: Occelli
authors.forename: Elena
authors.initials: E
authors.lastname: Fea
authors.forename: Abdelamid
authors.initials: A
authors.lastname: Heouaine
authors.forename: Milena
authors.initials: M
authors.lastname: Gasco
authors.forename: Marco
authors.initials: M
authors.lastname: Merlano
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004617:Embolism / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013927:Thrombosis / Q000139:chemically induced*; D013997:Time Factors; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine