PB1450 - Bleeding with VEGF and EGFR inhibitors in patients with lung cancer receiving therapeutic anticoagulation

Background: The safety of concurrent anticoagulation in patients with lung cancer receiving vascular endothelial growth factor inhibitors (VEGFi) is uncertain.

Aims: To compare rates of hemorrhage among patients with lung cancer receiving anticoagulation and concurrent chemotherapy versus VEGFi or endothelial growth factor receptor inhibitors (EGFRi).

Methods: Retrospective cohort study of patients with lung cancer receiving anticoagulation (excluding prophylactic-dose low-molecular-weight-heparin [LMWH]) from 2012 to 2022 at MSKCC. Patients were indexed on the first day of concurrent anticoagulation and anti-neoplastic therapy. Patients were identified using diagnostic codes and prescription data, and records were reviewed to identify outcomes over 15 months. Patients were censored for major bleeding, discontinuation of anticoagulation/anti-neoplastic therapy (60-days after last prescription), or death. The study exposure was type of anti-neoplastic therapy in the first 30 days post-index: chemotherapy alone (chemo); EGFRi with/without chemotherapy (EGFRi±chemo); VEGFi with/without chemotherapy (VEGFi±chemo). Study outcomes were ISTH-defined major bleeding and clinically relevant non-major bleeding (CRNMB) at 12 months. The cumulative incidence (95% confidence interval [CI]) of outcomes was calculated with death as a competing risk.

Results: The study included 295 patients: 126 chemo; 94 EGFRi±chemo (87 EGFRi alone); 75 VEGFi±chemo (21 VEGFi alone). There was a similar distribution of direct oral anticoagulants and LWMH between the 3 groups (Table 1). The overall 12-month cumulative incidence of major bleeding was 4.0% (95% CI 1.8%-7.7%) and CRNMB was 14% (9.7%-19%). The 12-month cumulative incidence of major bleeding was 6.3% in chemo alone, 5% in VEGFi±chemo and 1.1% in EGFRi±chemo groups. The 12-month cumulative incidence rates of CNRMB were similar across all anti-neoplastic groups (Figure 1).

Conclusion(s): The risk of major bleeding or CRNMB with anticoagulation appears similar in patients with lung cancer receiving chemotherapy alone versus those receiving VEGFi or EGFRi therapeutics. These data provide reassurance that VEGFi can be administered in patients requiring therapeutic anticoagulation.