Thromboembolic events in advanced non-small cell lung cancer

Background: Cancer is a prothrombotic condition and its treatment is often complicated in the presence of thromboembolisms (TE) which adds to its morbidity and mortality. We aimed to assess the incidence of TE’s in patients with NSCLC treated at our institute. Methods: A retrospective observational study of patients with NSCLC treated between January 2011 and December 2016 were included. Time of onset of TE’s either at diagnosis or after the start of platinum-based chemotherapy was noted, Khorana score was calculated in all patients with TE’s. A TE occurring between first dose of chemotherapy and 4 weeks after the last dose was considered to be chemotherapy associated. Results: On analysis of records from the EMR, we found a total of 1542 NSCLC patients who were treated at our institute, with a male to female ratio of 3.5 : 1. All patients with TE’s had stage IV disease at the time of presentation. Fifty-nine (3.8%) patients out of 1542 developed TE’s, 53 had venous TE and 6 had cerebral arterial infarction. Twenty-five (1.6%) had TE’s at the time of diagnosis while 34 (2.9%) out of 1180 developed TE while on treatment with platinum based chemotherapy. The mean age was 60 years (Range:34-81 yrs) with a male predominance (59%). Majority of patients developed TE’s within 100 days from the start of chemotherapy with a median time of 66 days. (Range:14-143 days) Intermediate and high risk groups on assessment of Khorana score was 61% and 39% respectively. The median overall survival for patients with TE was 129 days in comparison to 234 days for patients without thromboembolisms. Conclusions: Thromboembolism is associated with a poor prognosis in patients with advanced lung cancer. Patients receiving platinum-based chemotherapy are predisposed to higher incidences of thromboembolic events which raises a valid question of the need of thromboprophylaxis in a selected group of patients. Legal entity responsible for the study: Amrita Institute of Medical Science. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.