Prior chemotherapy linked to mortality risk among patients with thoracic cancers, COVID-19
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Prior use of chemotherapy appeared associated with an increased risk for death among patients with lung or other thoracic cancers and COVID-19, according to study results presented during the ASCO20 Virtual Scientific Program.
Patients with these malignancies who received anticoagulants and corticosteroids prior to COVID-19 diagnosis also had a higher risk for mortality, researchers noted.
“The initial publications on COVID-19 in the general population suggested a higher mortality rate among patients with cancer,” Leora Horn, MD, MSc, Ingram associate professor of cancer research, associate professor of medicine, assistant director of the educator development program and clinical director of the thoracic oncology program at Vanderbilt-Ingram Cancer Center, said during a presentation. “We were worried specifically about patients with thoracic cancer, and in less than a week we had a study enrolling patients. Some clinical trials [regarding COVID-19] are now being approved and funded within weeks, whereas before it could take months or years to get approval for a trial.”
Patients with thoracic cancers generally have been considered high risk because of their age, preexisting comorbidities, smoking, preexisting lung damage and previous therapies to treat their disease.
Horn and colleagues launched the global Thoracic Cancers International COVID-19 Collaboration to gather data on patients with thoracic malignancies and COVID-19. The consortium seeks to provide insight into the management of these patients and a better understanding of the impact of the novel coronavirus on hospitalization and death among this patient population.
Researchers analyzed 400 patients with thoracic malignancies and COVID-19, most of whom were undergoing active therapy.
Median follow-up was 15 days.
More than three-quarters of patients (78.3%, n = 334) were admitted to the hospital, 33 were admitted to the ICU and 20 received mechanical ventilation. Median length of hospital stay was 10 days.
Results showed about one-third (n = 141) of the patients died, with 112 (79.4%) dying of COVID-19, 15 (10.6%) dying of cancer, 12 (8.5%) dying of cancer and COVID-19 and two (1.4%) dying of unknown causes.
Risk factors associated with mortality included older age ( 65 years), the presence of a comorbidity, ECOG performance status, previous steroid use above 10 mg, previous anticoagulation and previous chemotherapy.
Researchers noted that only patients who received chemotherapy within 3 months of a COVID-19 diagnosis had a significantly higher risk for death due to the virus (64%) than patients who did not receive chemotherapy. In addition, use of corticosteroids prior to COVID-19 infection appeared associated with a 1.5 times higher risk for death among patients with thoracic cancer, after controlling for other factors.
Receipt of immunotherapy and tyrosine kinase inhibitors did not increase risk for mortality, nor did the type of treatment administered specifically for COVID-19.
“Data collection is ongoing, with additional analyses planned to look at patient and provider perceptions of COVID-19’s impact on cancer care,” Horn said. – by John DeRosier
References:
Horn L, et al. Abstract LBA111. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.
Perspective
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Charu Aggarwal, MD, MPH
Patients with Lung Cancer are at high risk for hospitalization and complications from COVID-19. Symptoms of COVID-19 can be difficult to differentiate from symptoms of lung cancer. The finding that immunotherapy or TKI use may not increase the risk of hospitalization is an important finding. Clinical guidelines should be developed to deliver safe and effective care for patients with lung cancer.
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Horn L, et al. Abstract LBA111. Presented at: ASCO20 Virtual Scientific Program; May 29-31, 2020.
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