The impact on survival of thromboembolic phenomena occurring before and during protocol chemotherapy in patients with advanced gastroesophageal adenocarcinoma

BACKGROUND. Thromboembolic events (TEEs) are considered common in patients with gastroesophageal carcinoma, but their frequency at baseline and during chemotherapy is not known. Because prophylactic anticoagulation results in improved overall survival (OS) of solid tumor patients, the authors hypothesized that TEEs at baseline and during chemotherapy would have an adverse effect on OS. METHODS. The authors analyzed patients with advanced gastroesophageal carcinoma who were treated on 4 prospective chemotherapy Phase II/III trials. Baseline and subsequent TEEs were documented and correlated with OS. RESULTS. On the 4 trials, 191 patients received single-agent or a combination of a taxane, camptothecin, platinum, or fluoropyrimidine. At baseline, TEEs occurred in 5.3% of untreated patients compared with 8.5% of previously treated patients (who had received prior treatment for metastatic disease). The median OS was only 3.9 months for patients who had a TEE at any time versus 8.7 months for patients who never developed a TEE (P = .007). TEEs at baseline were correlated with poor median OS in untreated patients (4.9 months vs 8.9 months for patients without a TEE; P = .014). There was no associated between TEEs and the type of chemotherapy used. CONCLUSIONS. The current results established that TEEs at baseline and/or during chemotherapy are frequent and result in poor OS for patients with advanced gastroesophageal carcinoma. Aggressive methods to treat or prevent TEEs are warranted.