Immune checkpoint inhibitors and venous thromboembolism in patients with head and neck cancer undergoing surgery

Venous thromboembolism (VTE) is associated with significant morbidity. Although this risk is multifactorial, recent studies suggest immune checkpoint inhibitors (ICIs) may also contribute to increased VTE risk. The aim of this study is to evaluate VTE risk in a cohort of patients with head and neck cancer treated with surgery and ICIs. De-identified data from the TriNetX Global Collaborative Network database was used to identify adult surgical patients (≥18 years) using International Classification of Diseases 10th Revision and Common Procedural Terminology codes and were further refined by use of nivolumab, pembrolizumab, or cemiplimab within 1-year before or up to 3-months after surgery. Cohorts were propensity score matched, and the primary study outcome was the 3-month composite rate of VTE. After propensity score matching, there were 1,471 patients in each cohort and they were well balanced according to demographics, body mass index, comorbidities, medication use, and radiation history up to 1-year before the index event. The composite rate of VTE in the study population was 3.7% and was higher in patients treated with ICIs (4.6% versus 2.9%; OR, 1.6; 95% CI, 1.1, 2.5). This study highlights the importance of risk stratification and risk reduction in the setting of increasing ICI use for patients with HNC undergoing surgery. People with cancer, including head and neck cancer (HNC), are at a higher risk of developing blood clots in their veins after surgery – known as venous thromboembolism (VTE). These clots can cause serious health problems. New treatments called immune checkpoint inhibitors (ICIs), such as nivolumab and pembrolizumab, help the immune system fight cancer but may also increase the risk of blood clots. In this study, we used a large international health database to look at adults with HNC who had surgery. We compared two groups: those who received ICIs around the time of surgery and those who did not. After making sure the two groups were similar in age, health conditions, and other factors, we found that patients who received ICIs had a higher rate of blood clots within three months after surgery (4.6%) compared to those who did not (2.9%). Our findings suggest that using ICIs around the time of surgery may increase the risk of blood clots in patients with HNC. As ICIs become more common in cancer treatment, it is important to consider this risk. Doctors should carefully assess each patient’s risk and consider steps to prevent blood clots when using ICIs in surgical cancer care.