How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?

Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...

I personally have not seen a major increase in incidence of thromboembolic events on CPIs. Patients with metastatic NSCLC run a 20% to 25% risk of clotting. It is hard to separate inherent risk from “added” risk. Other immune-mediated adverse events are far more concerning.

I have not previously considered this to be an IO-related toxicity. More to learn on this as we see more data.