Brief report: High incidence of peridiagnosis thromboembolic events in patients with BRAF-mutant lung cancer

• Published in: Thrombosis research Vol. 232; pp. 133 - 137
• Main Authors: Aparicio, Inmaculada, Iranzo, Patricia, Reyes, Roxana, Bote, Helena, Saigi, María, Bringas, Marianela, Bosch-Barrera, Joaquim, Corral, Jesús, Aparisi, Francisco, Ruffinelli, Jose C., Jiménez, Beatriz, Lage, Yolanda, López-Castro, Rafael, Majem, Margarita, Vázquez, Sergio, Artal, Ángel, Rodríguez-Pérez, Ángel, Lázaro-Quintela, Martín, Torres, José Miguel Sánchez, Reguart, Noemí, Cucurull, Marc, Gil-Bazo, Ignacio, Camps, Carlos, Nadal, Ernest, del Barrio, Anabel, Garrido, Pilar, Dómine, Manuel, Álvarez, Rosa, Muñoz, Andrés J., Calles, Antonio
• Format: Journal Article
• Language: English
• Published: 01-12-2023
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2023.11.007

INTRODUCTIONWe aimed to determine if advanced BRAF-mutant NSCLC has a higher thromboembolic events (TEE) rate than the expected.METHODSBetween 2008 and 2021, 182 patients with BRAF-mutant advanced NSCLC (BRAF V600E, n = 70; BRAF non-V600E, n = 112) were retrospectively identified from 18 centers in Spain. Patients received chemotherapy (n = 147), immunotherapy (n = 69), targeted therapy (n = 42), and immunotherapy + chemotherapy (n = 26).RESULTSIncidence rate of TEE was 26.4 % (95%CI: 19.9 %-32.9 %). A total of 72 TEE were documented among 48 patients, as 18 patients (37.5 %) developed more than one event. Median time to TEE onset was 2 months, 69 % of TEE occurred in the peridiagnostic period (+/- 90 days from cancer diagnosis), and in 16 pts. (33 %) TEE was the form of lung cancer presentation. Although most TEE were only venous (82 %; PE, n = 33; DVT, n = 16), arterial events were reported in 31 % and occurred earlier, or TEE presented in atypical locations (13.9 %). TEE were related to high hospitalization rate (59 %), recurrence (23 %), and mortality (10.4 %) despite appropriate anticoagulant/antiaggregant treatment. Median OS in patients without-TEE was 19.4 months (95%CI: 4.6-34.1), and significantly shorter in patients with arterial-TEE vs venous-TEE vs both of them: 9.9 months (95%CI: 0-23.5) vs 41.7 months (95%CI: 11.3-72.2 m) vs 2.7 months (95%CI: 2.1-3.3), p = 0.001. Neither clinical or molecular features (BRAF V600E/non-V600E), nor cancer treatment was associated to TEE occurrence. Khorana score underperformed to predict thrombosis at cancer diagnosis, as only 19.2 % of patients were classified as high-risk.CONCLUSIONSThrombotic events represent a new clinical feature of BRAF-mutant lung cancer. Patients with almost a 30 % incidence of TEE should be offered systematic anticoagulation.