Patients with non–small cell lung cancer (NSCLC) who have an ALK rearrangement may have an increased risk for venous thromboembolism and arterial thrombosis compared with NSCLC patients without an ALK rearrangement, according to a retrospective cohort study. The study findings were recently published in the Journal of Thoracic Oncology.
Using the Massachusetts General Hospital ALK Patient Database, study researchers identified 422 adults who were diagnosed with advanced-stage NSCLC and who had an ALK rearrangement between July 1, 2009, and July 1, 2019. A total of 385 adults who were diagnosed with advanced-stage NSCLC and no ALK rearrangement during the same time period were also identified at the institution.
Compared with patients with non-ALK–rearranged NSCLC, patients with ALK-rearranged NSCLC were on average 15.7 years younger (95% CI, 14.1-17.3 years) and tended to have a more favorable ECOG performance status, be a never or former smoker, and have a less systemic inflammatory disorders associated with venous thromboembolism. The only risk factor associated with venous thromboembolism seen among patient with ALK-rearranged NSCLC was a higher proportion of brain metastases.
Patients with ALK-rearranged NSCLC had a significantly higher proportion of venous thromboembolism (42.7% vs 28.6%; P <.0001) and similar proportion of arterial thrombosis (5% vs 4.4%; P =.71) compared with patients with non-ALK–rearranged NSCLC.
A multivariate Cox model and a competing-risks regression model both revealed that patients with ALK-rearranged NSCLC had an approximately 4-fold increased risk for venous thromboembolism compared with patients with non-ALK–rearranged NSCLC (Cox model: hazard ratio [HR], 3.70; 95% CI, 2.51-5.44; P <.001; competing-risks model: subhazard ratio [SHR], 3.91; 95% CI, 2.55-5.99; P <.001).
An additional multivariate Cox model and competing-risks regression model also showed that patients with ALK-rearranged NSCLC had an approximately 3-fold increased risk for arterial thrombosis compared with patients with non-ALK–rearranged NSCLC (Cox model: HR, 3.15; 95% CI, 1.18-8.37; P =.021; competing-risks model: SHR, 2.80; 95% CI, 1.06-7.43; P =.038).
The study authors offered several potential clinical implications for these findings, suggesting that patients with ALK rearrangements may benefit from prophylactic anticoagulation, and venous thromboembolism risk prediction scores may improve if ALK rearrangement status is incorporated.
Al-Samkari H, Leiva O, Dagogo-Jack I, et al. Impact of ALK rearrangement on venous and arterial thrombotic risk in non-small cell lung cancer [published online May 10, 2020]. J Thorac Oncol. doi: 10.1016/j.jtho.2020.04.033