Melina Verso1, Rita Chiari2, Stefano Mosca3, Laura Franco4, Matthias Fischer3, Luca Paglialunga2, Chiara Bennati2, Michele Scialpi3, Giancarlo Agnelli4. 1. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: melina.verso@unipg.it. 2. Medical Oncology, Perugia Hospital, Perugia, Italy. 3. Department of Diagnostic Imaging, Perugia Hospital, Perugia, Italy. 4. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
Abstract
BACKGROUND: Patients with stage IIIB-IV lung adenocarcinoma are at high-risk for pulmonary embolism (PE). In these patients, EGFR and KRAS mutations as well as EML4/ALK rearrangements are recognized as "drivers" and as targets for therapy. Data on the incidence of PE in oncogene-addicted lung cancer patients are limited. AIMS: The aims of this study were to evaluate the incidence of CT scan-detected PE in patients with stage IIIB-IV lung adenocarcinoma and to assess the potential correlation between the presence of these oncogenes and the PE risk. METHODS: Baseline staging or re-staging chest contrast-enhanced CT scans of patients with stage IIIB-IV lung adenocarcinoma were retrospectively reviewed and adjudicated for the presence of PE. Data on the oncogene drivers (EGFR, KRAS or EML4/ALK) of the same patients were collected. RESULTS: A total of 173 patients with lung adenocarcinoma were included in the study. 24.8% of patients were EGFR mutated (31/125), 21.6% were KRAS mutated (27/125) and 13.6% hadan EML4/ALK rearrangement (17/125). 41 patients had a CT-detected PE (23.7%). A PE was observed in 5 patients with EGFR mutation (16.2%), in 5 patients with KRAS mutation (18.5%), in 8 patients with ELM4/ALK mutation (47.1%). The presence of ELM4/ALK rearrangement was associated with an increased risk of PE [HR:2.06 (95%CI 1.08- 3.55)]. Risk of PE was not found to be associated with EGFR or KRAS mutations. CONCLUSIONS: Patients with advanced lung adenocarcinoma were at high risk for PE. The presence of EML4/ALK rearrangement was associated with an increased PE risk.
BACKGROUND:Patients with stage IIIB-IV lung adenocarcinoma are at high-risk for pulmonary embolism (PE). In these patients, EGFR and KRAS mutations as well as EML4/ALK rearrangements are recognized as "drivers" and as targets for therapy. Data on the incidence of PE in oncogene-addicted lung cancerpatients are limited. AIMS: The aims of this study were to evaluate the incidence of CT scan-detected PE in patients with stage IIIB-IV lung adenocarcinoma and to assess the potential correlation between the presence of these oncogenes and the PE risk. METHODS: Baseline staging or re-staging chest contrast-enhanced CT scans of patients with stage IIIB-IV lung adenocarcinoma were retrospectively reviewed and adjudicated for the presence of PE. Data on the oncogene drivers (EGFR, KRAS or EML4/ALK) of the same patients were collected. RESULTS: A total of 173 patients with lung adenocarcinoma were included in the study. 24.8% of patients were EGFR mutated (31/125), 21.6% were KRAS mutated (27/125) and 13.6% hadan EML4/ALK rearrangement (17/125). 41 patients had a CT-detected PE (23.7%). A PE was observed in 5 patients with EGFR mutation (16.2%), in 5 patients with KRAS mutation (18.5%), in 8 patients with ELM4/ALK mutation (47.1%). The presence of ELM4/ALK rearrangement was associated with an increased risk of PE [HR:2.06 (95%CI 1.08- 3.55)]. Risk of PE was not found to be associated with EGFR or KRAS mutations. CONCLUSIONS:Patients with advanced lung adenocarcinoma were at high risk for PE. The presence of EML4/ALK rearrangement was associated with an increased PE risk.
Authors: Andrew Dunbar; Kelly L Bolton; Sean M Devlin; Francisco Sanchez-Vega; Jianjiong Gao; Jodi V Mones; Jonathan Wills; Daniel Kelly; Mirko Farina; Keith B Cordner; Young Park; Sirish Kishore; Krishna Juluru; Neil M Iyengar; Ross L Levine; Ahmet Zehir; Wungki Park; Alok A Khorana; Gerald A Soff; Simon Mantha Journal: Blood Date: 2021-04-15 Impact factor: 25.476