A multicenter study of thromboembolic events among patients diagnosed with ROS1-rearranged non-small cell lung cancer
A multicenter study of thromboembolic events among patients diagnosed with ROS1-rearranged non-small cell lung cancer
复制标题
DOI：
10.1016/j.lungcan.2020.01.017
复制
发表时间：
2020-04-01
期刊：
影响因子：
5.3
通讯作者：
Itchins, Malinda
中科院分区：
文献类型：
--
作者：
Alexander, Marliese;Pavlakis, Nick;Itchins, Malinda
目的：本研究旨在描述与疾病自然史和ROS 1重排的非小细胞肺癌（NSCLC）临床过程相关的纵向血栓栓塞（TE）风险。材料和方法：汇总了来自澳大利亚6家医院的ROS 1重排NSCLC病例，并评价了静脉或动脉TE的发生率、时间、预测因素和结局，结果：42例患者中，20例（48%）发生TE，1例（2%）发生动脉血栓，13例（31%）发生肺栓塞，12例（29%）发生深静脉血栓。在TE患者中，6例（30%）发生了多起事件，3例为并发事件，3例为复发诊断。随着时间的推移，TE的累积发生率（将死亡作为竞争风险因素进行调整）接近50%。TE发生在围诊断期之前、期间和之后，并且与治疗策略无关。在筛选的n = 3/10（30%）例病例中确定了血栓形成倾向：2例凝血因子V Leiden和1例抗凝血酶III（ATIII）缺乏症。TE患者的中位OS为21.3个月，未TE患者的中位OS为28.8个月;风险比为1.16（95%CI 0.43-3.15）。TE一线治疗的ORR分别为50%和44%，而没有TE的化疗臂和67%与50%在靶向治疗arm.Conclusion：在罕见的癌症亚型，ROS 1，这些真实世界的数据表明，持续TE风险超出诊断期，无论治疗策略。PE、并发TE和复发性TE的高发生率需要在更大的队列中进行验证。建议在ROS 1人群中考虑一级血栓预防。
Objectives: This study aimed to describe the longitudinal thromboembolism (TE) risk relative to the natural history of disease and clinical course of ROS1 rearranged non-small cell lung cancer (NSCLC).Materials and Methods: Cases of ROS1-rearranged NSCLC from six Australian hospitals were pooled and evaluated for incidence, timing, predictors and outcomes of venous or arterial TE, as well as objective response rate (ORR) to active therapy and overall survival (OS).Results: Of 42 patients recruited, 20 (48%) experienced TE; one (2%) arterial, 13 (31%) a pulmonary emboli (PE), and 12 (29%) a deep vein thrombosis. Among those with TE, six (30%) experienced multiple events, three as concurrent and three as recurrent diagnoses. The cumulative incidence of TE over time, adjusted for death as a competing risk factor, approached 50%. TE occurred prior to, during and post the peri-diagnostic period and occurred irrespective of treatment strategy. A thrombophilia was identified in n = 3/10 (30%) cases screened: in two factor V Leiden and in one anti-thrombin III (ATIII) deficiency. Median OS was 21.3 months in those with TE vs. 28.8 months in those without; hazard ratio 1.16 (95%CI 0.43-3.15). Respective ORR to first-line therapy with TE was 50% vs. 44% without TE in the chemotherapy arm and 67% vs. 50% in the targeted therapy arm.Conclusion: In the rare cancer subtype, ROS1, these real-world data demonstrate sustained TE risk beyond the diagnostic period irrespective of therapeutic strategy. High incidence of PE, concurrent TE, and recurrent TE warrant validation in larger cohorts. Consideration of primary thromboprophylaxis in ROS1 populations is recommended.