Cancer-associated thrombosis (CAT) is a common complication in lung cancer patients. Lung cancer confers an increased risk of thrombosis compared to other solid malignancies across all stages of the disease. Newer treatment agents, including checkpoint immunotherapy and targeted agents, may further increase the risk of CAT. Different risk-assessment models, such as the Khorana Risk Score, and newer approaches that incorporate genetic risk factors have been used in lung cancer patients to evaluate the risk of thrombosis. The management of CAT is based on the results of large prospective trials, which show similar benefits to low-molecular-weight heparins (LMWHs) and direct oral anticoagulants (DOACs) in ambulatory patients. The anticoagulation agent and duration of therapy should be personalized according to lung cancer stage and histology, the presence of driver mutations and use of antineoplastic therapy, including recent curative lung surgery, chemotherapy or immunotherapy. Treatment options should be evaluated in the context of the COVID-19 pandemic, which has been shown to impact the thrombotic risk in cancer patients. This review focuses on the epidemiology, pathophysiology, risk factors, novel predictive scores and management of CAT in patients with active lung cancer, with a focus on immune checkpoint inhibitors.
癌症相关血栓形成是肺癌患者常见的并发症。在所有疾病阶段，肺癌患者发生血栓的风险均高于其他实体恶性肿瘤。新型治疗药物，包括免疫检查点抑制剂和靶向药物，可能进一步增加癌症相关血栓形成的风险。在肺癌患者中，已采用多种风险评估模型（如Khorana风险评分）及纳入遗传风险因素的新方法来评估血栓形成风险。癌症相关血栓形成的管理基于大型前瞻性试验结果，这些试验显示在门诊患者中，低分子量肝素与直接口服抗凝药具有相似的获益。抗凝药物选择及治疗时长应根据肺癌分期与组织学类型、驱动基因突变情况、抗肿瘤治疗方案（包括近期根治性肺手术、化疗或免疫治疗）进行个体化调整。治疗方案的选择需结合COVID-19大流行背景进行评估，已有证据表明该疫情会影响癌症患者的血栓形成风险。本综述重点探讨活动期肺癌患者癌症相关血栓形成的流行病学、病理生理学、风险因素、新型预测评分及管理策略，特别关注免疫检查点抑制剂的影响。
Lung Cancer Related Thrombosis (LCART): Focus on Immune Checkpoint Blockade
肿瘤(癌症)患者之家