Abstract Details

Title Thrombolysis for Ischemic Stroke in Patients With Malignancy at a Quaternary Cancer Center

Topic Neuro-oncology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 6-006

Objective To analyze outcomes of intravenous (IV) tissue plasminogen activator (tPA) in cancer patients.

Background IV thrombolysis is standard of care for patients with acute ischemic stroke (AIS)

Design/Methods We retrospectively analyzed outcomes of cancer patients and suspected AIS treated with IV tPA at Memorial Sloan Kettering Cancer Center (MSK) from 6/11/18 – 9/30/25. Active malignancy was defined as diagnosis or treatment of any malignant cancer within the past 6 months or known recurrent or metastatic disease. Importantly, MSK is not a designated stroke center, although it has an established acute stroke team activation system and 24-7 in-house neurology services.

Results Sixteen patients received tPA for presumed stroke during the study period. Median age was 71 years (range, 48-82); 6 patients were women. Twelve patients had active malignancy. No brain metastases or active CNS tumors. Initial median NIH Stroke Scale was 9 (range, 1-19) and Karnofsky performance status (KPS) was 100 (range, 20-100). After tPA, 9 patients were transferred to a comprehensive stroke center for further management, 1 was transferred locally for continued inpatient care, 1 died during the hospitalization, 2 were discharged home, and 3 to a rehabilitation center. Median KPS upon discharge was 60 (range, 0-90). Clinically significant systemic hemorrhage was reported in 2 patients following tPA: 1 bled at the site of recent abdominal surgery; 1 developed hemorrhage at a contusion site. No patients developed intracranial hemorrhage. Five patients with active malignancy resumed cancer-directed therapy within 3 months after the stroke. Median overall survival after tPA was 50.48 months (0-80 months).

Conclusions Our study suggests that treating carefully selected cancer patients and AIS with IV thrombolysis at a dedicated cancer center is feasible and safe. Further, a sizeable proportion of patients continued cancer-directed therapy and lived several years. These factors should be considered when weighing thrombolysis decisions in the oncological population.

Authors/Disclosures
Milena Lobaina, MD PRESENTER	Dr. Lobaina has nothing to disclose.
David Q. Mao, MD (Memorial Sloan Kettering)	Dr. Mao has nothing to disclose.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.
Edward Avila, DO, FAAN (Memorial Sloan-Kettering Cancer Center)	Dr. Avila has received publishing royalties from a publication relating to health care.
Lauren Schaff, MD, FAAN (Memorial Sloan Kettering Cancer Center)	Dr. Schaff has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint. Dr. Schaff has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BTG, plc. The institution of Dr. Schaff has received research support from BTG, plc. Dr. Schaff has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Ono.

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