gms | German Medical Science

Background: Arterial thromboembolic events during platinum-based chemotherapy for testicular cancer are rare adverse events, but might lead to a significant complication of treatment management.

Material and methods: We performed a retrospective analysis including 467 testicular germ cell tumors patients who received platinum-based chemotherapy from 2000 to 2021.

Results: 9/467 (2%) patients experienced an arterial thromboembolic event: 6 (67%) suffered from a myocardial infarction (5 STEMI, 1 NSTEMI) and 2 (22%) from a thrombosis of the lower extremity artery and cerebral infarction, respectively. All patients received 3 cycles of platinum-based chemotherapy (8x BEP, 1x PEI), 5 patients as first-line treatment in clinical stage IS or II and 3 patients due to relapse after initial active surveillance. In 1/3 of all patients, chemotherapy had to be postponed or stopped due to the thromboembolic event, respectively. Of these, 1 patient relapsed but was successfully treated by retroperitoneal lymphadenectomy. Arterial thrombosis mainly occurred after/during the first cycle of chemotherapy (4 patients). All but one patient received prophylactic anticoagulation using low-molecular-weight heparin for the entire chemotherapy treatment. All patients with myocardial infarction were treated with stent implantations without residuals, while leg amputation was necessary in one patient with thrombosis of the lower extremity artery. The patient with cerebral infarction was treated with thrombectomy, but still suffers from aphasia.

Conclusion: 2% of all patients treated by platinum-based chemotherapy due to testicular cancer suffered from an arterial thromboembolic event, potentially leading to delay/discontinuation of treatment or severe complications. A prospective, multicentre trial to evaluate anticoagulation options in this vulnerable group of patients is planned.