Mortality unexpectedly high among people with lung cancer, COVID-19
Click Here to Manage Email Alerts
Mortality appeared unexpectedly high among individuals with lung cancer and COVID-19 infection, according to international registry data presented at the virtual American Association for Cancer Research Annual Meeting.
More than one-third (34.6%) of the first 200 patients included in the TERAVOLT registry died, with the vast majority of causes attributed to infection with the novel coronavirus, Marina Chiara Garassino, MD, of Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, said during a presentation.
Initial data from China showed less than 1% of patients with the novel coronavirus had cancer; however, subsequent reports showed COVID-19 infection rates were higher among those with malignancy than the general population. A meta-analysis published earlier this year in Journal of Clinical Oncology showed pooled prevalence of 2% among individuals with cancer.
“Patients with cancer and cancer survivors remain an important vulnerable population for COVID-19 [infection],” Garassino said. “We were prepared for a pandemic lasting days or weeks, but we were not prepared for a pandemic lasting for months, if not for years ... so I think it’s very important to try to identify those patients who are at higher risk for COVID-19. Otherwise, in the attempt to try to reduce COVID infection, we could potentially increase the risk for cancer and cancer mortality.”
The TERAVOLT registry — which emerged from those considerations — launched March 15.
At AACR Annual Meeting, Garassino presented the first results of the global collaboration.
Inclusion criteria include individuals with any thoracic cancer and COVID-19 either confirmed by laboratory analysis, clinical symptoms and exposure, suspected due to imaging, or asymptomatic but confirmed with reverse transcription polymerase chain reaction.
To date, 200 patients (median age, 68 years; 70.5% men) from 21 countries have been included. The majority were current or former smokers (81.1%), had non-small cell lung cancer (75.5%) and had stage IV disease (73.5%).
Most patients (83.8%) had at least one comorbidity, 26.8% had two comorbidities and 26.8% had three or more. The most common were hypertension (47%), chronic obstructive pulmonary disease (25%), ischemic heart disease (15.2%) and diabetes (14.6%).
Most patients (73.9%) were on current treatment. The most common treatment types were chemotherapy alone (32.7%), immunotherapy alone (23.1%), tyrosine kinase inhibitor alone (19%) and chemotherapy-immunotherapy (13.6%).
The most reported symptoms upon COVID-19 diagnosis included fever (64.1%), dyspnea (53.5%), cough (52%) and fatigue (27.3%).
“These symptoms overlap with lung cancer, and differential diagnosis is very challenging,” Garassino said.
The most reported complications among registry participants were pneumonia (79.6%), acute respiratory distress syndrome (26.8%), multiorgan failure (7.6%) and sepsis (5.1%).
The majority of patients (76%) required hospitalization, but only 8.8% were admitted to the ICU — possibly due to shortages and institutional rules, Garassino said — and only 2.5% required mechanical ventilation.
Overall, 34.6% of patients included in the registry to date have died.
Researchers found no association between any specific lung cancer treatment and risk for death or hospitalization.
“However, the [sample size is limited] and we are collecting more information to confirm these results,” Garassino said.
Multivariate analysis adjusted for the most important COVID-19 risk factors in the general population did not reveal a specific risk profile for patients with thoracic cancers. However, ORs were higher than 1 for all factors, including COPD (OR = 1.44; 95% CI, 0.72-2.84), hypertension (OR = 1.25; 95% CI, 0.66-2.37), male sex (OR = 1.69; 95% CI, 0.83-3.44) and age older than 65 years (OR = 1.58; 95% CI, 0.8-3.11).
Additional analyses with more patients will be performed, Garassino said.
Garassino acknowledged limitations to the registry, including the small number of selected patients and short follow-up.
“However, with a strong united community we were able to activate a global registry and provide preliminary data in only 1 month in absence of dedicated funding,” Garassino said. – by Mark Leiser
Disclosure: Garassino reports financial relationships with AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Incyte, Merck Sharpe & Dohme, Pfizer, Roche, Seattle Genetics, Takeda and several other pharmaceutical companies.
Perspective
Back to Top
Karen L. Reckamp, MD, MS
This group definitely should be congratulated for doing this work so quickly. The time from idea generation to analysis of data from the first 200 patients was less than a month.
We still need to understand these data better. The mortality numbers were quite high, but the numbers for patients who got intubated or sent to the ICU were not very high. This may be due to the stage of their cancer, as two-thirds of patients had metastatic disease. It may be the state of the disease — perhaps they had poor performance status. Or maybe there is a regional explanation, given most of these patients were treated in Europe. Whatever the reasons, we need to know more.
The inclusion of patients with suspected COVID-19 infection who didn’t necessarily test positive concerns me. Patients with lung cancer get shortness of breath and cough pretty regularly. They also can have abnormal imaging of their lungs. I’m not sure how you could differentiate a patient who does or doesn’t have COVID-19 or another type of pneumonia unless you had a positive test, so a deeper understanding of outcomes for those who tested positive vs. those who had clinical symptoms will need to be teased out.
This is interesting information. We are only at the beginning of what we need to know, and it is very important that we continue the effort to create and contribute to registries like this because we have almost no data. We don’t want to treat our patients based on a cohort of 18 patients, 100 patients or even 200 patients. Yet, here we are. We’ll take any data that come at us, but we have to be smart about it and understand that this study is retrospective, which does not allow us to formulate firm conclusions.
Read more about
Click Here to Manage Email Alerts