ALK-Rearranged Non–Small-Cell Lung Cancer Is Associated With a High Rate of Venous Thromboembolism

Alona Zer*, Mor Moskovitz, David M. Hwang, Anat Hershko-Klement, Ludmila Fridel, Grzegorz J. Korpanty, Elizabeth Dudnik, Nir Peled, Tzippy Shochat, Natasha B. Leighl, Geoffrey Liu, Ronald Feld, Ronald Burkes, Mira Wollner, Ming Sound Tsao, Frances A. Shepherd

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


We examined the rate of venous thromboembolism in a cohort of consecutive patients with ALK-rearranged non–small-cell lung cancer (NSCLC) at a single center and found it to be 3- to 5-fold higher than previously reported in the setting of advanced NSCLC. The results were comparable when we included a validation cohort of consecutive patients at 2 other centers, with an overall rate of 36%. Prospective confirmation is warranted. Background Patients with lung cancer are at increased risk for venous thromboembolism (VTE), particularly those receiving chemotherapy. It is estimated that 8% to 15% of patients with advanced non–small-cell lung cancer (NSCLC) experience a VTE in the course of their disease. The incidence in patients with specific molecular subtypes of NSCLC is unknown. We undertook this review to determine the incidence of VTE in patients with ALK (anaplastic lymphoma kinase)-rearranged NSCLC. Patients and Methods We identified all patients with ALK-rearranged NSCLC diagnosed and/or treated at the Princess Margaret Cancer Centre (PM CC) in Canada between July 2012 and January 2015. Retrospective data were extracted from electronic medical records. We then included a validation cohort comprising all consecutive patients with ALK-rearranged NSCLC treated in 2 tertiary centers in Israel. Results Within the PM CC cohort, of 55 patients with ALK-rearranged NSCLC, at a median follow-up of 22 months, 23 (42%) experienced VTE. Patients with VTE were more likely to be white (P = .006). The occurrence of VTE was associated with a trend toward worse prognosis (overall survival hazard ratio = 2.88, P = .059). Within the validation cohort (n = 43), the VTE rate was 28% at a median follow-up of 13 months. Combining the cohorts (n = 98), the VTE rate was 36%. Patients with VTE were younger (age 52 vs. 58 years, P = .04) and had a worse Eastern Cooperative Oncology Group performance status (P = .04). VTE was associated with shorter overall survival (hazard ratio = 5.71, P = .01). Conclusion The rate of VTE in our ALK-rearranged cohort was 3- to 5-fold higher than previously reported for the general NSCLC population. This warrants confirmation in larger cohorts.

Original languageEnglish
Pages (from-to)156-161
Number of pages6
JournalClinical Lung Cancer
Issue number2
StatePublished - 1 Mar 2017
Externally publishedYes


  • Anaplastic lymphoma kinase (ALK)
  • Thrombosis
  • Venous thromboembolism


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