Incidence of Ct scan-detected pulmonary embolism in patients with oncogene-addicted, advanced lung adenocarcinoma

•Patients with advanced lung cancer are reported to be at high risk for VTE.•The expression of specific oncogene drivers is known for patients with advanced lung cancer.•We found a correlation between ELM4/ALK and incidence of PE in lung cancer patients.•ELM4/ALK could be used to identify patients with lung cancer at very high risk for PE.•In these cancer patients an antithrombotic prophylaxis could be proposed

BackgroundPatients 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.AimsThe 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.MethodsBaseline 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.ResultsA 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.ConclusionsPatients with advanced lung adenocarcinoma were at high risk for PE. The presence of EML4/ALK rearrangement was associated with an increased PE risk.