Arterial Thromboembolism in Patients With Advanced Lung Cancer: Secondary Analyses of the Rising-VTE/NEJ037 Study

Area of Science:

• Oncology
• Cardiology
• Hematology

Background:

• Cancer-associated thromboembolism (CAT) is a known complication, with direct oral anticoagulants (DOACs) established for venous thromboembolism (VTE) treatment.
• However, the risks of arterial thromboembolism (ATE) and DOAC efficacy in cancer patients remain unclear.
• This study focuses on advanced lung cancer patients, a population at high risk for thromboembolic events.

Purpose of the Study:

• To evaluate risk factors for arterial thromboembolism (ATE) in patients with advanced lung cancer.
• To assess the clinical activity of edoxaban (EDO) in preventing ATE in this patient group.
• To investigate the relationship between venous thromboembolism (VTE) and arterial thromboembolism (ATE) in advanced lung cancer.

Main Methods:

• Secondary analysis of the prospective Rising-VTE/NEJ037 study involving 1008 patients with newly diagnosed advanced lung cancer.
• Patients with VTE were treated with edoxaban (EDO), and ATE events were monitored over a 2-year follow-up period.
• Multivariate analysis was used to identify independent risk factors for ATE.

Main Results:

• The incidence of ATE was 4.1% (41 patients) over 2 years, with cerebral infarction being the most common event (75.6%).
• Independent risk factors for ATE included VTE, D-dimer levels, and atrial fibrillation.
• For patients with VTE, ATE incidence was 15.9% with EDO and 11.1% without EDO (p=0.626), indicating no significant difference.

Conclusions:

• Arterial thromboembolism (ATE) occurs in 4.1% of advanced lung cancer patients over 2 years.
• Venous thromboembolism (VTE) is an independent risk factor for ATE in this population.
• Direct oral anticoagulants (DOACs) demonstrated limited efficacy in preventing ATE among advanced lung cancer patients with VTE.