Risk of Vascular Toxicity with Platinum-based Chemotherapy in Elderly Patients with Bladder Cancer

Platinum-based chemotherapy is widely used for bladder cancer, but is associated with vascular toxicity, especially thromboembolism. We evaluated short-term (

We identified Medicare beneficiaries age 66-94 years diagnosed with stage II-III bladder cancer from 1998-2007 in the Surveillance, Epidemiology and End Results-Medicare database. We measured the association between platinum-based chemotherapy and vascular events (thromboembolic and non-thromboembolic) using Cox proportional hazard regression models.

The sample included 5,057 patients, 21. 3% of whom received platinum-based chemotherapy. Patients receiving platinum-based chemotherapy were more likely to be younger and male with less comorbidity than patients not receiving any chemotherapy. During the first year after diagnosis, patients who received platinum-based chemotherapy had higher risk of thromboembolic event (19. 8% vs. 11. 6%, AHR: 1. 43, 95% CI: 1. 17-1. 75) compared to those who did not receive chemotherapy. The likelihood of having a thromboembolic outcome was similar whether platinum chemotherapy was cisplatin- (21. 1%, AHR=1. 56, 95% CI: 1. 22-2. 00) or carboplatin-based (18. 9%, AHR=1. 35, 95% CI: 1. 07-1. 71). During years 2-5 after diagnosis there was no significant association between platinum chemotherapy and the risk of thromboembolic events. The risk of non-thromboembolic vascular events was not elevated with platinum chemotherapy in either time period.

Patients receiving platinum based chemotherapy were at higher risk of developing thromboembolism, but not other vascular events, particularly within the first year after diagnosis. This risk of thromboembolism is similar for both cisplatin and carboplatin.

The Journal of urology. 2015 Sep 01 [Epub ahead of print]

Amit Gupta, Jessica B Long, Jersey Chen, Cary P Gross, Darren R Feldman, Richard M Steingart

Department of Urology, University of Iowa, Iowa City, Iowa. Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale School of Medicine, New Haven, Connecticut. , Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, Maryland. , Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale School of Medicine, New Haven, Connecticut. , Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. , Cardiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.

PubMed