Predictors for the development of thromboembolic events in cancer patients treated with bevacizumab, ramucirumab, and aflibercept: a single-institution retrospective analysis.

Introduction The risk of thromboembolic events developing limits the dose of anti-angiogenic agents, thereby reducing their efficacy. This retrospective study therefore sought to identify predictors for the development of anti-angiogenic agent-induced thromboembolic events and to elucidate whether differences in the likelihood of thromboembolic events exist between different anti-angiogenic agents or cancer types, to guide future strategies for optimizing safety, efficacy, and quality of life in patients receiving chemotherapy. Methods This study retrospectively investigated 468 cancer patients who received chemotherapy with bevacizumab, ramucirumab, or aflibercept at our outpatient chemotherapy center between December 2016 and April 2022. Variables related to the development of thromboembolic events were extracted from the medical records and multivariate logistic regression analysis was performed to identify predictors for the development of thromboembolic events. The Wilcoxon/Kruskal-Wallis test was used to detect significant differences between groups. Results Significant factors included serum albumin level (odds ratio [OR] = 0.363, 95% confidence interval [CI] = 0.193-0.685; P = 0.0017) and diabetes mellitus (OR = 5.356, 95%CI = 1.711-16.769; P = 0.0039). RAS inhibitors (OR = 0.307) had low OR, although it was not significant. No difference in the development of thromboembolic events was evident between cancer types (P = 0.0781), but differences were identified between the three anti-angiogenic agents (P = 0.0132). Ramucirumab was associated with a lower likelihood of thromboembolic events. Conclusion Serum albumin level and diabetes mellitus were identified as significant predictors for the development of anti-angiogenic agent-induced thromboembolic events. In addition, the likelihood of thromboembolic events did not differ between cancer types, but differed between antiangiogenic agents.