Cisplatin chemotherapy (without erythropoietin) and risk of life-threatening thromboembolic events in carcinoma of the uterine cervix: the tip of the iceberg? A review of the literature

A review of several prospective trials demonstrates no treatment related grade 4 cardiovascular toxicities and only two grade 5 toxicities in 1424 (0.1%) collective patients. A recent publication and our own unpublished experience finds 6 of 128 (4.7%) patients developed grade 4 to 5 cardiovascular (thrombosis/embolism) toxicity. The differenc in incidence of severe or life threatening cardiovascular toxicity of 0.1 versus 4.7% is highly statistically significant (p < 0.00001.)This dramatic difference in incidence of cardiovascular toxicity raises the possibility that cardiovascular toxicities were inadequately reported on the listed prospective trials. For those patients enrolled in prospective trials, we suggest that thromboses should be diligently documented and reported. Only after the true incidence of thromboses is established can we implement appropriate levels of early screening and intervention that may prevent life threatening complications.A retrospective, case control study of 147 with carcinoma of the cervix or vagina treated with chemoradiotherapy with or without erythropoietin showed a 23 versus 3% incidence of TE. [1] Such recent findings of an elevated risk of cardiovascular toxicity, specifically thromboembolic events (TE), in patients receiving concurrent irradiation, cisplatin chemotherapy and erythropoietin have spurred interest in the true incidence of TE in patients receiving concurrent irradiation and cisplatin chemotherapy in the absence of erythropoietin.The use of cisplatin, either alone or in combination with other chemotherapeutic agents, has become the standard of care for the treatment of various solid tumors. Specifically, the routine use of cisplatin in the treatment of cancers of the uterine cervix has been cemented with the publication of several recent prospective randomized trials [2-8].When reporting the results of these prospective trials, the scoring of treatment related toxicity is site specific. For example, TE are scored as