Incidence, Risk factors, and Outcomes of Thromboembolism in Patients with Melanoma Receiving Immune Checkpoint Inhibitors, Chemotherapy, or Targeted Therapy: a SEER-Medicare Analysis.

Authors

Tamara A Sussman, Long Vu, Siran M Koroukian, Alok A Khorana

Published in

Journal of thrombosis and haemostasis : JTH. Sep 12, 2026. Epub Sep 12, 2026.

Abstract

Little is known about venous thromboembolism (VTE) and arterial thromboembolism (ATE) risk in melanoma patients receiving immune checkpoint inhibitors (ICI), compared to other therapies.
We assessed incidence, risk factors, and impact on survival of thromboembolism (TE) in patients receiving ICI, chemotherapy, or targeted therapy.
We conducted a cohort study using SEER-Medicare to evaluate TE rates in patients treated 2008-2019 with ICI, chemotherapy, or BRAF/MEK inhibitors within two years after treatment initiation. Associations between TE, treatment, and clinical risk factors were evaluated using weighted competing risk regression (CRR). Overall survival was estimated by Kaplan-Meier and Cox regression models.
Among 6,218 patients, 62.1% (3,860) received first line ICI, 30.4% (1,890) chemotherapy, and 7.5% (468) targeted therapy. Cumulative incidence of VTE was similar among all treatment types: 7.7% for ICI, 8.4% for chemo, and 7.4% for targeted therapy at 12 months (p=0.80). Similarly, ATE rates were 5.3% for ICI, 5.0% for chemo, and 6.5% for targeted therapy at 12 months (p=0.30). History of VTE (SHR: 2.81; [95%CI: 2.19-3.61]) and brain metastases (SHR: 1.33 [1.06-1.66]) were associated with increased risk of VTE. When compared to chemotherapy, ICI and targeted therapy had similar VTE risk (p>0.05). For ATE, cardiovascular disease (SHR: 1.49 [1.14-1.93]), diabetes mellitus (SHR: 1.27 [1.04-1.57]), history of ATE (SHR: 1.61 [1.13-2.29]), and antiplatelet therapy (SHR: 1.37 [1.03-1.83]) were associated with increased risk. Patients with VTE or ATE experienced two-fold worse survival (HR: 2.17 [1.64-2.87] and HR: 2.58 [1.92-3.47], respectively). In ICI sub-analysis, combination ipilimumab/nivolumab had higher cumulative incidence of VTE: 11.9% at 12 months, 9.3% for ipilimumab, 7.5% for pembrolizumab, and 5.8% for nivolumab (p<0.05). When compared to nivolumab, combination ipilimumab/nivolumab (SHR: 1.66 [1.09-2.54]) and ipilimumab (SHR: 1.43 [1.03-2.00]) had greater VTE risk. VTE and ATE were associated with worse survival (HR: 3.24 [2.30-4.58] and HR: 1.89 [1.20-2.99], respectively).
ICI, chemotherapy, and targeted therapy are associated with a high incidence of TE; TE is associated with substantial worsening of survival.

PMID:
42731732
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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