From the Guidelines
There is no established maximum CHA2DS2-VASc score that would preclude initiating atezolizumab and bevacizumab therapy, as this score is primarily used to assess stroke risk in patients with atrial fibrillation and guide anticoagulation decisions, not to determine eligibility for cancer immunotherapy or antiangiogenic therapy 1.
Key Considerations
- The CHA2DS2-VASc score is a tool for assessing thromboembolic risk in atrial fibrillation patients, with a score of 2 or more indicating elevated risk and recommending oral anticoagulation 1.
- When considering atezolizumab and bevacizumab combination therapy, clinicians should evaluate cardiovascular risk factors individually, given the potential cardiovascular side effects of these medications, such as hypertension and arterial thromboembolic events.
- A comprehensive benefit-risk assessment should be conducted, taking into account the patient's cancer type, stage, cardiovascular status, and overall health, rather than relying solely on the CHA2DS2-VASc score.
Clinical Approach
- Patients with significant cardiovascular disease history should undergo careful assessment before initiating atezolizumab and bevacizumab therapy.
- A cardio-oncology consultation may be beneficial for patients with multiple cardiovascular risk factors or pre-existing cardiovascular disease.
- Treatment decisions should prioritize minimizing cardiovascular risks while effectively managing the patient's cancer, considering the latest guidelines and evidence-based practices, such as those outlined in the 2024 ESC guidelines for the management of atrial fibrillation 1.
From the Research
CHA2DS2-VASc Score and Atezolizumab Bevacizumab Therapy
- The CHA2DS2-VASc score is used to predict the risk of stroke in patients with atrial fibrillation, but its relevance to atezolizumab and bevacizumab therapy is not directly established in the provided studies 2, 3, 4, 5, 6.
- However, the score can be used to assess the overall cardiovascular risk of a patient, which may be relevant when considering the initiation of any new therapy, including atezolizumab and bevacizumab.
- The maximum CHA2DS2-VASc score is 9, but there is no specific guidance on the maximum score for initiating atezolizumab and bevacizumab therapy.
Risk Factors and Score Calculation
- The CHA2DS2-VASc score includes the following risk factors: Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or transient ischemic attack, Vascular disease, Age 65-74 years, and Sex category (female) 2.
- Each risk factor is assigned a point value, and the total score is calculated by adding the points for each risk factor present.
Clinical Relevance and Decision-Making
- The decision to initiate atezolizumab and bevacizumab therapy should be based on individual patient factors, including their overall health status, cancer type and stage, and other medical conditions 5.
- While the CHA2DS2-VASc score can provide information on cardiovascular risk, it should be considered in the context of other clinical factors and not used as the sole determinant for initiating therapy.
- Studies have shown that the CHA2DS2-VASc score can help identify patients with atrial fibrillation who are at low risk of stroke and may not require oral anticoagulant therapy 6.