Worse outcomes for some cancers in COVID-19 disease, early data suggests

Lung cancer

By Michael Woodhead and Karen Olsen

6 May 2020

Oncologists from several countries have used the AACR 2020 virtual meeting to report their early experiences of the impact of COVID-19 disease in cancer patients, and how the outcomes are affected by factors such as stage and location of disease.

A relatively positive picture was described by Dr Fabrice Barlesi from the Gustave Roussy Cancer Campus in Paris. In a review of 137 patients with cancer and COVID-19 disease he noted that the mortality rate (14.6%) was comparable to the estimated mortality rates from COVID-19 in France overall (17.9%) at the time of the study.

Most patients had solid tumours (119 patients), with breast cancer being the most common cancer. Approximately 60% of patients had advanced disease, while around 40% were in remission or were being treated for localised disease. More than 20% of patients were asymptomatic for COVID-19.

Roughly 25% of patients exhibited clinical worsening, defined as the need for oxygen supplementation of 6 L/minute or more, or death of any cause. Overall, 11% of patients were admitted to the ICU, and nearly 15% of patients died. All fatalities were related to COVID-19. Significant predictors of clinical worsening included having an ECOG status greater than 1, having a haematological cancer or having received chemotherapy treatment within the last three months. Among these patients treated with chemotherapy, those with metastatic disease had an increased risk of death, while those with localised disease did not, as compared with patients that did not receive a recent chemotherapy treatment.

Worse outcomes in New York and China

However, two other presentations at AACR 2020 from oncologists in New York and China reported that patients with cancer had significantly increased odds of death.

The New York study evaluated 218 patients with cancer and COVID-19 treated in the Montefiore Health System. It found that patients with cancer had more than twice the odds of death compared to a cohort of 1,000 patients with COVID-19 without cancer treated at the same hospital.

Mortality rates among patients with cancer revealed that those with lung cancer, gastrointestinal cancers, gynaecologic malignancies, and haematologic malignancies had the highest rates of death.

Similarly, a Chinese study based on registry data from 105 cancer patients with COVID-19 found that compared with patients with COVID-19 without cancer, those with cancer and COVID-19 had over twice the odds of death. Patients with cancer had roughly three times the odds of intensive care unit (ICU) admissions, had nearly three times the odds of developing at least one severe or critical symptom, and had significantly higher odds of invasive mechanical ventilation.

The study also showed that patients with metastatic disease had an increased rate of severe events: those with stage 4 cancer had more than five times the odds of death. Patients with localised cancer, on the other hand, had similar outcomes to those without cancer.

It also found that patients who received immunotherapy had the highest odds of death, and patients who received immunotherapy or surgery had the highest odds of developing a severe or critical symptom.

Thoracic cancers and COVID-19

The AACR 2020 meeting also heard reports from European oncologists suggesting that lung involvement may be a risk for higher mortality with COVID-19 disease

Dr Carlos Gomez-Martin from Madrid, Spain, talked outlined information pertaining to the first 63 patients with cancer and COVID-19 admitted at his institution. More than half of patients developed respiratory failure, nearly 40% developed ARDS and 25% of patients died from COVID-19.  Dr Gomez-Martin noted that patients with cancer with lung involvement, an ECOG status of 2 or higher, severe neutropenia, or those with bilateral lung infiltrates during their baseline CT scan had significantly increased mortality.

To further investigate the impact of COVID-19 disease in lung cancer patients, Italian oncologists have set up a global registry, called TERAVOLT (Thoracic cancERs international coVid 19 cOLlaboraTion), which has already accumulated reports from 260 patients with thoracic cancers.

“The goals of this consortium are to provide data for guidance to oncology professionals on managing patients with thoracic malignancies while understanding the risk factors for morbidity and mortality from this novel virus,” said Dr Marina Chiara Garassino from Istituto Nazionale dei Tumori in Milan.

Dr Garassino  said their analysis of outcomes for the first 200 patients  – mostly with NSCLC- enrolled in TERAVOLT registry is that suggested that COVID-19 is associated with more severe complications in patients with thoracic cancers.

The most reported complication in this patient population was pneumonia/pneumonitis, affecting almost 80% of evaluable patients. Further, almost 27% of patients had ARDS. Over 75% of patients were hospitalised, and almost 35% of patients died, either at the hospital, in the ICU, or at home.

“Our data suggest an unexpectedly high mortality among thoracic cancer patients,” Dr Garassino said. The cause of death in the large majority of patients is attributed to COVID-19 and not cancer, she added.

“Things are moving quickly,” Garassino said, noting that this collaboration is registering roughly 70 patients per week from across the globe. “With a strong united thoracic community, we were able to activate a global registry and provide preliminary data in only one month, in absence of dedicated funding.”

AACR President-Elect Dr Antoni Ribas told the meeting that the AACR has set up a COVID-19 and Cancer Task Force and will include sessions on COVID-19 and cancer in Virtual Annual Meeting II, held June 22-24. The AACR is also holding a dedicated meeting focused on COVID-19 and cancer in July, and a call for abstracts on this topic will be circulated soon.

This feature is based on an article published on 1 May from Cancer Research Catalyst, the American Association for Cancer Research’s official blog.

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