1. Service d’Hématologie Biologique Hôpital Tenon, APHP, Paris, France Group Thrombosis and Cancer Cancer Biology and Therapeutics Centre de Recherche Saint-Antoine INSERM U938 Université Pierre et Marie Curie  In patients with lung adenocarcinoma, metastasis, advanced stage and chemotherapy (CTx) are factors which increase the risk of venous thromboembolism (VTE). However, routine pharmacological thromboprophylaxis is not recommended but individualized risk assessment for VTE is encouraged  Lung Adenocarcinoma stands out among the types of cancer with a high risk for VTE, having an adjusted relative risk (RR) ratio of 22 compared with non cancer patients  The development of risk assessment models (RAM) to stratify the risk of VTE adapted for cancer patients and prospective clinical validation is necessary  A multicenter cross-sectional observational study of the Tenon Thrombosis group (COMPASS - Study), identified the most frequent and clinically relevant risk factors for VTE in medical and surgical patients which can be used to create a RAM model adapted to specific patients’ settings The incorporation of biomarkers of blood hypercoagulability int the RAM could improve its sensitivity to identify patients eligible for thromboprophylaxis.  To this aim we conducted an observational prospective study, in patients with lung adenocarcinoma, to investigate the variability of haematological biomarkers (HB) associated with hypercoagulability, with respect to adenocarcinoma-related characteristics Introduction Results The present study evaluated a wide spectrum of biomarkers of cellular and plasma hypercoagulability in patients with lung adenocarcinoma We established that the increase of procoagulant phospholipids in plasma, the up-regulation of TF pathway, the enhanced D-Dimers formation and heparanase release is a universal phenomenon in lung cancer Chemotherapy enhances both cellular and plasma hypercoagulability Variations of thrombin generation and FVIIa levels allow to identify subgroups of patients who present hypercoagulability Baseline values of TGT, PPL, HPA were found to be related with 3-month mortality and the incidence of thrombotic episodes These data allow to propose that the weighted incorporation of biomarkers of cellular and plasma hypercoagulabilty in RAMs for VTE might improve their predictive value. This concept is being studied on an ongoing trial Conclusion Differential Influence of Lung Cancer Stage, Time from Diagnosis and Chemotherapy on Plasma and Cellular Biomarkers of Hypercoagulability. The ROADMAP Study Ilias Evmorfiadis 1,2, Paraskevi Boura 3, Aurélie Rousseau 1,2,4, Ariadni Charpidou 2, Giannis Giozos 2, Patrick Van Dreden 4, Konstantinos Syrigos 2, Anastasia Spanoudaki 5, Matthieu Grusse 4, Ismail Elalamy 1,2 and Grigoris T. Gerotziafas 1,2 1 Service d’Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France 2 INSERM U938, Faculté de Médecine Pierre et Marie Curie, Université Paris VI, Paris, France 3 Oncology Unit GPP, 3rd Department of Medicine, Athens School of Medicine, Athens, Greece 4 Research and Development, Diagnostica Stago, Gennevilliers, France Patients and Methods Patients and study design  Patients with documented lung adenocarcinoma eligible for CTx at distance of at least 3 months from surgery or hospitalization were included in the study (n=80). Patients were either CTx naive (n=46) or had already received CTx (n=34). The control group (CG) consisted of 30 healthy age & sex-matched individuals.  Patients were assessed at baseline on the day of their entry in the study, and after 3 months follow- up. HB screening took place at baseline and after 3 cycles of CTx and one month after last CTx or before change of therapy line  Thrombin generation (TGT) in citrated PPP was assessed with the Thrombogram-Thrombinoscope® assay using PPP-reagent®5 pm TF by Diagnostica Stago. The levels of P-Selectin and heparanase (HPA) in plasma were measured with ELISA Kit (Cusabio Biotech and R&D Systems respectively). The procoagulant phospholipids clotting time (PPL) was measured with STA-Procoag-PPL®,levels of Factor VIIa by Staclot VIIa-rTF®, D-Dimers (DDi) by Liatest D-Di (Diagnostica Stago, France), and Tissue Factor activity (TFa) by specific clotting based home test  Patients’ mortality and symptomatic thrombotic events were recorded Figure 1. Baseline hypercoagulability markers in patients (D-Dimers, MRI & Heparanase) according to mortality in the 3 month follow-up period * p<0,05 versus CG $ p<0,05 versus NG  Patients showed significantly shortened PPL and significantly higher levels of TFa, D-Dimer and HPA as compared to the CG. The levels of FVIIa were significantly lower in patients compared to CG  P-Selectin levels and endogenous thrombin potential (ETP) did not differ between the two groups. The chronometric parameters of TGT (lag-time, and ttPeak) were significantly prolonged. The velocity of the propagation phase of TGT (MRI) was significantly lower in patients as compared to CG  The Naive Group of patients (NG) showed significantly shorter lag-time and lower ETP as compared to the On Treatment Group (OTG). The NG showed significantly higher levels of HPA as compared to the OTG (Table I.) Hypercoagulability BiomarkersAll Patients (n=79) NG (n=29) OTG (n=50) CG (n = 30) PPL-ct (sec)27±6*27±7*27,6±7,5*62,8±9 TFa (ng/ml)6.2±4.7*6,2±4*6,6±5,2*0,26±0.1 DD (μg/ml)1,8±2,2*1,1±1*1,4±1,2*0,3±0.01 HPA (ng/ml)0,4±1,2*0,32±0.12 $ *0,23±0,1*0,12±0,02 FVIIa (U/ml)37±20*34±16*34±20*50,9±11 P-Selectin (ng/ml)65,4±2064,8±1562,6±1962,6±10 Lag-time (min)4,3±0,8*3,9±1 $ 4,5±0,9*2,5±0.01 ttPeak (min)7.7±1.4*7±18,7±1,3*5±1 MRI (nM/min)91±40*94±4187,3±33*110±24 Peak (nM)279±71*279±76284±62*288±36 ETP (nM.min)1583±3281567±3261673±315* $ 1496±191 Table I. Baseline hypercoagulability markers in patients stratified according to Chemotherapy status (naive or on-treatment) Figure 4. Baseline hypercoagulability markers in patients according to thrombosis in the 3 month follow-up period Figure 3. Baseline hypercoagulability markers in patients according to cancer stage Figure 2. Baseline hypercoagulability markers in patients according to cancer grade  Patients who died within the 3-month follow-up (31%) had higher baseline levels of DDi and lower HPA levels as compared to those who were still alive (Fig. 1)  The increase of TGT, as well as that of HPA, P-Selectin, FVIIa was associated with the grade of the disease (Fig. 2)  Patients with metastatic cancer had higher levels of P-Selectin, TFa, DDi, FVIIa, TGT and HPA as compared to patients with localized or advanced disease (Fig. 3)  Patients who experienced a thrombotic episode (5%) had significantly higher baseline levels of TGT, shorter PPL and lower levels of HPA as compared to those who remained without thrombosis (Fig 4)