1. Arterial and Venous Thromboembolism in ALK-Rearrangement-Positive Non-small Cell Lung Cancer: A Population-Based Cohort Study.
- Author
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Icht, Oded, Leader, Avi, Batat, Erez, Yosef, Lilach, Shochat, Tzippy, Goldstein, Daniel A, Dudnik, Elizabeth, Spectre, Galia, Raanani, Pia, Hammerman, Ariel, and Zer, Alona
- Subjects
THROMBOEMBOLISM risk factors ,LUNG cancer ,VEINS ,CONFIDENCE intervals ,TIME ,MULTIVARIATE analysis ,COMMUNITY health services ,RETROSPECTIVE studies ,DISEASE incidence ,REGRESSION analysis ,ANAPLASTIC lymphoma kinase ,RISK assessment ,THROMBOEMBOLISM ,DESCRIPTIVE statistics ,DATA analysis software ,LONGITUDINAL method ,PROPORTIONAL hazards models - Abstract
Introduction There is scarce data regarding the incidence of venous thromboembolism (VTE) and arterial thromboembolism (ATE) in the molecular subtypes of non-small cell lung cancer (NSCLC). We aimed to investigate the association between Anaplastic Lymphoma Kinase (ALK) -positive NSCLC and thromboembolic events. Methods A retrospective population-based cohort study of the Clalit Health Services database, included patients with NSCLC diagnosed between 2012 and 2019. Patients exposed to ALK-tyrosine-kinase inhibitors (TKIs) were defined as ALK -positive. The outcome was VTE (at any site) or ATE (stroke or myocardial infarction) 6 months prior to the diagnosis of cancer, until 5 years post-diagnosis. The cumulative incidence of VTE and ATE and hazard-ratios (HR) with 95% CIs were calculated (at 6- 12- 24 and 60-months), using death as a competing risk. Cox proportional hazards multivariate regression was performed, with the Fine and Gray correction for competing risks. Results The study included 4762 patients, of which 155 (3.2%) were ALK -positive. The overall 5-year VTE incidence was 15.7% (95% CI, 14.7-16.6%). ALK -positive patients had a higher VTE risk compared to ALK -negative patients (HR 1.87 [95% CI, 1.31-2.68]) and a 12-month VTE incidence of 17.7% (13.9-22.7%) compared to 9.9% (9.1-10.9%) in ALK -negative patients. The overall 5-year ATE incidence was 7.6% [6.8-8.6%]. ALK positivity was not associated with ATE incidence (HR 1.24 [0.62-2.47]). Conclusions In this study, we observed a higher VTE risk, but not ATE risk, in patients with ALK- rearranged NSCLC relative to those without ALK rearrangement. Prospective studies are warranted to evaluate thromboprophylaxis in ALK -positive NSCLC. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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