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Qi Y, Wang X, Guo T, You T, Wang P. Correlation between ALK+ non-small cell lung cancer targeted therapy and thrombosis: a systematic review and network meta-analysis. BMJ Open 2024; 14:e078173. [PMID: 39349372 PMCID: PMC11448140 DOI: 10.1136/bmjopen-2023-078173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024] Open
Abstract
OBJECTIVE The main adjuvant therapies for anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer include ALK tyrosine kinase inhibitors (TKI) and chemotherapy. We aimed to compare differences in the incidence of thromboembolism (TE) among different treatment options. DESIGN Using a systematic review and Bayesian network meta-analysis (NMA). DATA SOURCES We searched PubMed, Embase, Cochrane Library, ClinicalTrials.gov and Web of Science databases before 10 June 2023. ELIGIBILITY CRITERIA We included published randomised controlled trials (RCT) involving comparisons of treatments between chemotherapy and ALK-TKI drugs. DATA EXTRACTION AND SYNTHESIS Assessed risk bias with Cochrane tool. Conducted NMA with GEMTC in R, we evaluate the model fit using the deviation information criteria. Estimated posterior distribution using Markov Chain Monte Carlo, 4 chains, 10 fine-tuned iterations, 10 000 iterations per chain, total 50 000 iterations. Monitored potential scale reduction factor for convergence. And checked convergence with Gelman-Rubin statistics and trace plot. Provided surface under the cumulative ranking, lower values indicate less TE event probability. RESULTS Analysis of eight RCTs showed that, compared with that for crizotinib, there was a lower risk of total TE with chemotherapy (OR, 0.28; 95% credible intervals (CrI) 0.11 to 0.63), brigatinib (OR 0.31; 95% CrI 0.11 to 0.79) and ceritinib (OR 0.13; 95% CrI 0.03 to 0.45). In addition, analysis of venous TE (VTE) showed similar results, with a lower occurrence for chemotherapy (OR 0.27; 95% CrI 0.1 to 0.62), brigatinib (OR 0.18; 95% CrI 0.04 to 0.6) and ceritinib (OR 0.1; 95% CrI 0.02 to 0.43) compared with that for crizotinib. There were no significant differences in the occurrence of arterial TE among the different treatment options. CONCLUSION Compared with chemotherapy, alectinib, lorlatinib, brigatinib and ceritinib, crizotinib significantly increased the risk of TE and VTE. PROSPERO REGISTRATION NUMBER CRD42023373307.
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Affiliation(s)
- Yaopu Qi
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiuhuan Wang
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Tai Guo
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Tiebin You
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ping Wang
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Yang X, Yang B, Li D, Pan W, Tong Q, Wang L, Chen D, Fu C. Thromboembolic Events Associated with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors: A Pharmacovigilance Analysis of the US FDA Adverse Event Reporting System (FAERS) Database. Clin Drug Investig 2024; 44:199-207. [PMID: 38376794 DOI: 10.1007/s40261-024-01346-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND OBJECTIVES Although thromboembolic events (TEEs) have been reported with the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), their association remains largely unknown. In this study, we aimed to provide a comprehensive review of TEEs associated with EGFR-TKIs. METHODS We collected EGFR-TKIs (gefitinib, erlotinib, afatinib, and osimertinib) adverse reaction reports from 2015 Q1 to 2023 Q1 from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. Disproportionality analysis was conducted to identify thromboembolic adverse events associated with EGFR-TKIs by comparing them with the overall FAERS database according to the reporting odds ratio (ROR). Associated factors were explored using univariate logistic regression. RESULTS We identified 1068 reports of TEEs associated with EGFR-TKIs (1.24% accounts for all TEEs). Affected patients were females (49.72%) and those older than 65 years (41.20%). The reported TEE case fatality was 30.24%. The median time to onset (TTO) of all cases was 39 days [interquartile range (IQR) 11-161], and the median TTO of fatalities [31 days (IQR 10-116)] was significantly shorter than that of non-fatal cases [46 days (IQR 12-186)]. CONCLUSION This study yielded three key findings. Firstly, EGFR-TKIs seem to exhibit prothrombotic effects, elevating the risk of TEEs. Secondly, the clinical outcomes of TEEs associated with EGFR-TKIs were poor. Thirdly, most TEEs occurred within the initial 3 months, and fatal cases occurred earlier than non-fatal cases.
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Affiliation(s)
- Xiongwen Yang
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China
| | - Bo Yang
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China
| | - Dan Li
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China
| | - Wei Pan
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China
| | - Qin Tong
- Department of Oncology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Lili Wang
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China
| | - Danjun Chen
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China
| | - Chengxiao Fu
- Department of Pharmacy, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China.
- Institute of Pharmacy and Pharmacology, College of Basic Medical Science, Hengyang Medical School, University of South China, Hengyang, 421200, Hunan, People's Republic of China.
- Clinical Pharmacology Research Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, People's Republic of China.
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3
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Recuero-Borau J, Masfarré L, Navarro N, Rocha P, Taus Á, Arriola E. Non-bacterial thrombotic endocarditis in ROS1-rearranged lung cancer: a report of two cases. Transl Lung Cancer Res 2024; 13:179-185. [PMID: 38404995 PMCID: PMC10891407 DOI: 10.21037/tlcr-23-412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/15/2023] [Indexed: 02/27/2024]
Abstract
Background Lung cancer is one of the tumor types with highest incidence of thromboembolic events (TE), especially adenocarcinoma subtype. ROS1 rearrangements confer higher risk of TE. Non-bacterial thrombotic endocarditis (NBTE) is a rare event, frequently diagnosed on autopsy. Clinical suspicion is key to reach the diagnosis and start early treatment of the underlying cause and anticoagulation in order to improve patients' outcomes. Case Description Here we present two cases of NBTE in patients with ROS1-rearranged lung cancer with different clinical debuts. A 42-year-old woman presented initial tetraplegia and impaired level of consciousness, and the other patient, a 54-year-old man, was diagnosed of stroke with sensitive loss of left body. Both were diagnosed of NBTE, confirmed by the finding of cardiac vegetation on echocardiogram and no microorganisms found on blood cultures. Both responded well to targeted therapy with lorlatinib and crizotinib and anticoagulation with heparin. Conclusions NBTE is an infrequent disease which can cause severe neurological symptoms that impair quality of life, performance status and survival. Early clinical suspicion in patients with higher risk of TEs such as patients with rearrangements of ROS1 gene is of essence. Adequate management of underlying disease and anticoagulation may impact in the recovery of symptoms.
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Affiliation(s)
| | - Laura Masfarré
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Nil Navarro
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Pedro Rocha
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Álvaro Taus
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
| | - Edurne Arriola
- Department of Medical Oncology, Hospital del Mar, Barcelona, Spain
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4
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Aguiar De Azevedo L, Orione C, Tromeur C, Couturaud F, Descourt R, Geier M. Incidence of venous thromboembolism and association with PD-L1 expression in advanced non-small cell lung cancer patients treated with first-line chemo-immunotherapy. Front Oncol 2024; 13:1221106. [PMID: 38260845 PMCID: PMC10800377 DOI: 10.3389/fonc.2023.1221106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background Venous thromboembolism (VTE) is a serious complication in non-small cell lung cancer (NSCLC) patients. The use of thromboprophylactic therapy is subject to an accurate assessment of the VTE risk depending on patients, tumor characteristics and type of systemic antineoplastic treatments. However, little is known concerning the risk of VTE in patients suffering from an advanced NSCLC treated with first-line chemo-immunotherapy and the impact of tumor biomarkers such as PD-L1 expression. Methods We performed a retrospective, observational, single-centre study in a cohort of advanced NSCLC patients treated with first-line chemo-immunotherapy. The primary endpoint was the incidence of VTE. Secondary endpoints were the cumulative incidence of VTE, the impact of PD-L1 on VTE occurrence, overall survival, the rate of VTE recurrence under anticoagulant treatment and the rate of bleeding complications. Results 109 patients were included, of whom 21 (19.3%) presented a VTE event during a median follow-up of 13 months. VTE incidence at 3, 6 and 12 months was 12.1%, 15.1% and 17.5% respectively. 61% were pulmonary embolisms, 9.5% were isolated deep vein thrombosis and 14.3% were central venous catheter-related thrombosis. Our study did not show a significant impact of PD-L1 on VTE occurrence. Overall survival at 6, 12 and 24 months was 81.9%, 74.4% and 70.3% respectively. Four patients developed a recurrent VTE under anticoagulation therapy 3 to 5 months after the first VTE event. One patient suffered from a major bleeding complication while under anticoagulation therapy, leading to death. Conclusion VTE is a common complication in advanced NSCLC patients treated with concomitant chemo-immunotherapy. In our study, 19.3% of patients developed a VTE during a median follow-up of 13 months. PD-L1 did not appear to be associated with VTE occurrence. We recorded high VTE recurrence rates despite anticoagulant treatment. Further investigations are needed to determine if high PD-L1 expression is associated with VTE.
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Affiliation(s)
| | - Charles Orione
- Service de Pneumologie, Centre Hospitalier de Cornouaille, Quimper, France
| | - Cécile Tromeur
- Service de Pneumologie, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
| | - Francis Couturaud
- Service de Pneumologie, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
| | - Renaud Descourt
- Service d’oncologie médicale, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
| | - Margaux Geier
- Service d’oncologie médicale, Centre Hospitalier Regional Universitaire de Brest, Brest, Brittany, France
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5
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Emilescu RA, Jinga M, Cotan HT, Popa AM, Orlov-Slavu CM, Olaru MC, Iaciu CI, Parosanu AI, Moscalu M, Nitipir C. The Role of KRAS Mutation in Colorectal Cancer-Associated Thrombosis. Int J Mol Sci 2023; 24:16930. [PMID: 38069251 PMCID: PMC10707331 DOI: 10.3390/ijms242316930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Venous thromboembolic events (VTE) are common in patients with colorectal cancer (CRC) and represent a significant contributor to morbidity and mortality. Risk stratification is paramount in deciding the initiation of thromboprophylaxis and is calculated using scores that include tumor location, laboratory values, patient clinical characteristics, and tumor burden. Commonly used risk scores do not include the presence of molecular aberrations as a variable. This retrospective study aims to confirm the link between KRAS-activating mutations and the development of VTE in CRC. A total of 166 patients were included in this study. They were split into two cohorts based on KRAS mutational status. We evaluated the frequency and mean time to VTE development stratified by the presence of KRAS mutations. Patients with mutant KRAS had an odds ratio (OR) of 2.758 for VTE compared to KRAS wild-type patients, with an increased risk of thrombosis being maintained in KRAS mutant patients even after adjusting for other known VTE risk factors. Taking into account the results of this study, KRAS mutation represents an independent risk factor for VTE.
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Affiliation(s)
- Radu Andrei Emilescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Mariana Jinga
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Horia Teodor Cotan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Ana Maria Popa
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Cristina Maria Orlov-Slavu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Mihaela Cristina Olaru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Cristian Ion Iaciu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Andreea Ioana Parosanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
| | - Mihaela Moscalu
- Preventive Medicine and Interdisciplinarity Department, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Cornelia Nitipir
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (R.A.E.)
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Aldea M, Marinello A, Guyon D, Gazzah A, Barlesi F, Planchard D, Besse B. Prevalence of Thromboembolic Events in Patients With Non-Small Cell Lung Cancer and RET Fusions. JAMA Oncol 2023; 9:1583-1584. [PMID: 37707807 PMCID: PMC10502692 DOI: 10.1001/jamaoncol.2023.3625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 09/15/2023]
Abstract
This cohort study examines the incidence, risks, and characteristics of deep vein thrombosis, pulmonary embolism, arterial thrombosis, and stroke among patients with non–small cell lung cancer (NSCLC) and RET fusions.
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Affiliation(s)
- Mihaela Aldea
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
- Faculty of Medicine, Paris Saclay University, Paris, France
| | - Arianna Marinello
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - David Guyon
- Department of Medical Oncology, Neuro-oncology Unit, Gustave Roussy, Villejuif, France
| | - Anas Gazzah
- Department of Drug Development Department, CICT, Gustave Roussy, Villejuif, France
| | - Fabrice Barlesi
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
- Faculty of Medicine, Paris Saclay University, Paris, France
| | - David Planchard
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
| | - Benjamin Besse
- Department of Medical Oncology, International Center for Thoracic Cancers (CICT), Gustave Roussy, Villejuif, France
- Faculty of Medicine, Paris Saclay University, Paris, France
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Liu Z, Song P, Zhou L, Ji D, Shen H, Dong H, Feng X. Osimertinib for an Advanced NSCLC Patient with Two Common EGFR Mutations and a Concomitant MET Exon 14 Skipping Mutation: A Case Report. Cancer Manag Res 2023; 15:645-650. [PMID: 37465082 PMCID: PMC10350420 DOI: 10.2147/cmar.s412199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
Background Lung cancer remains the leading cause of cancer-related mortality. Studies have revealed that a combination of crizotinib and EGFR tyrosine kinase inhibitors (TKIs) could be an effective treatment option for patients with sensitizing EGFR mutations and de novo or acquired MET amplification. Until now, there have been few reports of the response in patients harboring three mutations. Case Presentation A patient was diagnosed with advanced lung adenocarcinoma harboring EGFR Del19, L858R mutation and METex14. She received osimertinib, and repeated imaging revealed further tumor progression. Sixty-six days later, combined treatment with osimertinib and crizotinib was initiated. Unfortunately, the patient succumbed to death at home after 17 days. Conclusion This report firstly provided a lung adenocarcinoma patient with two common EGFR mutations (Del19 and L858R) and METex14. Our case raises a reminder about the tolerance and safety of combination therapy, especially in older peoples.
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Affiliation(s)
- Zhicong Liu
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
| | - Pengtao Song
- Department of Pathology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
| | - Lingyan Zhou
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
| | - Dongxiang Ji
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
| | - Hui Shen
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
| | - Hui Dong
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
| | - Xueren Feng
- Department of Respiratory Medicine, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, People’s Republic of China
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Zhao J, Ma Z, Li H, Sun D, Hu Y, Zhang C, Zhang Y. Risks of cardiovascular toxicities associated with ALK tyrosine kinase inhibitors in patients with non-small-cell lung cancer: a meta-analysis of randomized control trials. Expert Opin Drug Saf 2023; 22:581-588. [PMID: 36803384 DOI: 10.1080/14740338.2023.2182284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Anaplastic lymphoma kinases (ALK) tyrosine kinase inhibitors (TKIs) are effective and safe targeted therapies used in advanced ALK-positive non-small cell lung cancers (NSCLC). However, ALK-TKIs associated cardiovascular toxicities in patients with ALK-positive NSCLCremain incompletely characterized. We conducted the first meta-analysis to investigate this. RESEARCH DESIGN AND METHODS To determine the cardiovascular toxicities associated with these agents, we carried out a meta-analysis comparing ALK-TKIs with chemotherapy and a meta-analysis comparing crizotinib with other ALK-TKIs. Statistical analysis was conducted to calculate the RRs and 95% confidence intervals (CIs) by using either random effects or fixed-effect models according to the heterogeneity of the included studies. RESULTS A total of 11 studies (2855 patients) were included. ALK-TKIs ranked to have more severe cardiovascular toxicities than chemotherapy (RR 5.03, 95% CI 1.97-12.84, P = 0.0007) . Compared with other ALK-TKIs, increased risks of cardiac disorders and VTEs associated with crizotinib were found (cardiac disorders RR 1.75, 95% CI 1.07-2.86, P = 0.03; risk of VTEs RR 3.97, 95% CI 1.69-9.31, P = 0.002; respectively). CONCLUSION ALK-TKIs were associated with higher risks of cardiovascular toxicities. Special attention should be given to the risks of cardiac disorders and VTEs related to crizotinib therapy.
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Affiliation(s)
- Jin Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, Hebei, China
| | - Zhuo Ma
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, Hebei, China
| | - Hao Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, Hebei, China
| | - Dan Sun
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, Hebei, China
| | - Yi Hu
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, Hebei, China
| | - Chen Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, Hebei, China
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, Hebei, China
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Xiong W, Guo X, Du H, Xu M, Zhao Y. Management of venous thromboembolism in patients with lung cancer: a state-of-the-art review. BMJ Open Respir Res 2023; 10:10/1/e001493. [PMID: 37068846 PMCID: PMC10111887 DOI: 10.1136/bmjresp-2022-001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
Venous thromboembolism (VTE) is common and life-threatening in patients with lung cancer. Management of VTE is critical for patients with lung cancer. Risk assessment, thromboprophylaxis and treatment of VTE constitute the core issues of VTE management in patients with lung cancer. Although its overall principles should follow recommendations in authoritative guidelines, VTE management in patients with lung cancer may be slightly special in some specific aspects. Despite the extensive validation of Khorana score for patients with all cancer types, its value in VTE risk assessment of patients with lung cancer is controversial. It is important to determine the VTE risk assessment score that can accurately and specifically assess the VTE risk of patients with lung cancer. Clinical practice patterns of thromboprophylaxis may vary by cancer types, since different sites of cancer may have different levels of VTE risk. To understand the thromboprophylaxis specific for lung cancer is of vital importance for patients with lung cancer. Although it is essential to comply with authoritative guidelines, the duration and timing of initiation of thromboprophylaxis in surgical patients with lung cancer may need further study. Taken together, the purpose of this review is to provide an overview of state-of-the-art VTE stewardship specific for patients with lung cancer.
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Affiliation(s)
- Wei Xiong
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuejun Guo
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - He Du
- Department of Medical Oncology, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Mei Xu
- North Bund Community Health Service Center, Hongkou District, Shanghai, China
| | - Yunfeng Zhao
- Department of Pulmonary and Critical Care Medicine, Shanghai Punan Hospital, Shanghai, China
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10
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Yi J, Chen H, Li J, Jiang X, Xu Y, Wang M, Wang Z, Zhai Z, Ren Y, Zhang Y. The association between ROS1 rearrangement and risk of thromboembolic events in patients with advanced non-small cell lung cancer: a multicenter study in China. Thromb J 2022; 20:56. [PMID: 36167545 PMCID: PMC9513881 DOI: 10.1186/s12959-022-00417-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background According to several studies, ROS1 rearrangement is associated with thrombotic risk in non-small cell lung cancer (NSCLC). However, there is no clear understanding of the predictors and prognostic impact of thromboembolic events (TEEs) in patients with advanced ROS1 rearrangement NSCLC. Methods A total of 47 newly diagnosed advanced NSCLC patients with ROS1 rearrangement from four Chinese hospitals were retrospectively included and were evaluated for TEEs incidence, characteristics, predictors, as well as response to therapies and overall survival (OS). Results Of the 47 enrolled patients, 23.4% (n = 11) patients developed TEEs. Among them, 7 of 11 patients (64%) developed pulmonary embolism (PE), and 5 patients (45%) experienced recurrent TEEs. In multivariate analysis, D-dimer was associated with the occurrence of TEEs in ROS1 rearranged NSCLC (HR 1.16, 95% CI 1.08–1.23, P < 0.001). Median progression-free survival (PFS) after first-line ROS1 tyrosine kinase inhibitors (TKIs) therapy was significantly longer in patients without TEEs than in those developing TEEs (26 months vs. 12 months, P = 0.0383). Furthermore, patients with TEEs had a shorter OS period than those without TEEs (29.8 months vs. not estimable, P = 0.0647). Conclusion The results of this multicenter study indicated that advanced NSCLC patients with ROS1 rearrangement were more likely to experience PE and TEEs recurrence. And patients with TEEs tended to have a worse prognosis. Furthermore, an elevated D-dimer level suggested a hypercoagulable state in NSCLC patients with ROS1 rearrangement.
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Affiliation(s)
- Jiawen Yi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Huang Chen
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Jie Li
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China
| | - Xingran Jiang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Wang
- Department of Pathology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yanhong Ren
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
| | - Yuhui Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Institute of Respiratory Medicine, Beijing, China.
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11
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Tawil N, Rak J. Blood coagulation and cancer genes. Best Pract Res Clin Haematol 2022; 35:101349. [DOI: 10.1016/j.beha.2022.101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
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12
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Moik F, Ay C. Venous and arterial thromboembolism in patients with cancer treated with targeted anti-cancer therapies. Thromb Res 2022; 213 Suppl 1:S58-S65. [DOI: 10.1016/j.thromres.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
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13
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Tamura R, Yoshihara K, Enomoto T. Therapeutic Strategies Focused on Cancer-Associated Hypercoagulation for Ovarian Clear Cell Carcinoma. Cancers (Basel) 2022; 14:2125. [PMID: 35565252 PMCID: PMC9099459 DOI: 10.3390/cancers14092125] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023] Open
Abstract
Ovarian clear cell carcinoma (OCCC) is associated with chemotherapy resistance and poor prognosis, especially in advanced cases. Although comprehensive genomic analyses have clarified the significance of genomic alterations such as ARID1A and PIK3CA mutations in OCCC, therapeutic strategies based on genomic alterations have not been confirmed. On the other hand, OCCC is clinically characterized by a high incidence of thromboembolism. Moreover, OCCC specifically shows high expression of tissue factor and interleukin-6, which play a critical role in cancer-associated hypercoagulation and may be induced by OCCC-specific genetic alterations or the endometriosis-related tumor microenvironment. In this review, we focused on the association between cancer-associated hypercoagulation and molecular biology in OCCC. Moreover, we reviewed the effectiveness of candidate drugs targeting hypercoagulation, such as tissue factor- or interleukin-6-targeting drugs, anti-inflammatory drugs, anti-hypoxia signaling drugs, anticoagulants, and combined immunotherapy with these drugs for OCCC. This review is expected to contribute to novel basic research and clinical trials for the prevention, early detection, and treatment of OCCC focused on hypercoagulation.
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Affiliation(s)
| | - Kosuke Yoshihara
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; (R.T.); (T.E.)
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14
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Alma S, Eloi D, Léa V, Julie C, Valérie M, Pierre G, Hilgers W, Philippe G, Christine Z, Philippe D. Incidence of venous thromboembolism and discriminating capacity of Khorana score in lung cancer patients treated with immune checkpoint inhibitors. J Thromb Thrombolysis 2022; 54:287-294. [PMID: 35396660 DOI: 10.1007/s11239-022-02649-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Venous-thromboembolism (VTE) is increased in lung cancer patients (LCP) treated with immune-checkpoint inhibitors (ICIs) but risk factors are not identified and the Khorana Score (KS) is not validated. To assess VTE incidence and its clinical impact, to investigate potential clinical risk factors and KS performance in LCP. Retrospective analysis of LCP initiating ICIs treatment between June 2015 and November 2020 in a for-profit cancer center. 481 patients were included: 62% adenocarcinoma, 70% PDL1 + , 86% stage-IV-disease. Over a median follow-up of 9.8 months, 47 VTE were observed: 28 pulmonary embolisms, 15 deep venous thromboses (distal n = 9, proximal n = 6), 3 inferior vena cava thromboses, 1 other VTE, no superficial or digestive vein thrombosis. Median time from ICIs' initiation to VTE was 180 (11-1277) days. Overall survival was significantly lower in patients who experienced VTE (42.5 vs. 86.8 months, p = 0.006). In univariate analysis patients VTE was more frequent in metastatic patients (11.1% vs. 1.5%, p = 0.015) and lower in those treated with durvalumab (1.9% vs. 9.6%, p = 0.046). Logistic regression analysis showed that non-metastatic status (OR 0.13; 0.02-0.95, p = 0.04) and BMI (OR 1.07; 1.01-1.14, p = 0.028) were associated with VTE. The rate of VTE was the same in patients with a KS < or ≥ 2 (10.2% vs. 9.3%, p = 0.87). ICIs-treated LCP are at high risk of thromboembolism. VTE has a negative impact on survival. KS does not perform well in LCP. It is important to identify which VTE prediction models are available to be used in adult ambulatory lung cancer patients.
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Affiliation(s)
- Stancu Alma
- Thoracic Oncology Unit, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France
| | - Debourdeau Eloi
- Department of Ophthalmology, Gui de Chauliac Hospital, 34000, Montpellier, France
- Institute for Neurosciences of Montpellier INM, Univ. Montpellier, INSERM, 34091, Montpellier, France
| | - Vazquez Léa
- Supportive Care Unit, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France.
| | - Coussirou Julie
- Pharmacy, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France
| | - Matagne Valérie
- Pharmacy, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France
| | - Grassi Pierre
- Thoracic Oncology Unit, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France
| | - Werner Hilgers
- Thoracic Oncology Unit, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France
| | - Girard Philippe
- Thoracic Oncology Unit, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France
| | - Zammit Christine
- Vascular Medicine Department, Hôpital Des Portes de Camargue, route d'Arles, 13150, Tarascon, France
| | - Debourdeau Philippe
- Supportive Care Unit, Institut Sainte Catherine, 250 chemin de baigne pieds, 84918, Avignon Cedex 09, France
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15
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Yan AR, Samarawickrema I, Naunton M, Peterson GM, Yip D, De Rosa S, Mortazavi R. Risk Factors and Prediction Models for Venous Thromboembolism in Ambulatory Patients with Lung Cancer. Healthcare (Basel) 2021; 9:778. [PMID: 34205695 PMCID: PMC8233898 DOI: 10.3390/healthcare9060778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/13/2021] [Accepted: 06/17/2021] [Indexed: 12/21/2022] Open
Abstract
Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed and updated models may be promising, but their further validation is needed.
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Affiliation(s)
- Ann-Rong Yan
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
| | - Indira Samarawickrema
- School of Nursing, Midwifery and Public Health, Faculty of Health, University of Canberra, Canberra 2617, Australia;
| | - Mark Naunton
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
| | - Gregory M. Peterson
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
- College of Health and Medicine, University of Tasmania, Hobart 7005, Australia
| | - Desmond Yip
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
- Department of Medical Oncology, The Canberra Hospital, Garran 2605, Australia
- ANU Medical School, Australian National University, Canberra 0200, Australia
| | - Salvatore De Rosa
- Department of Medical and Surgical Science, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Reza Mortazavi
- School of Health Sciences, Faculty of Health, University of Canberra, Canberra 2617, Australia; (A.-R.Y.); (M.N.); (G.M.P.); (D.Y.)
- Prehab Activity Cancer Exercise Survivorship Research Group, Faculty of Health, University of Canberra, Canberra 2617, Australia
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