Chemotherapy for gynecologic cancer does not increase COVID-19 hospitalization, death
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Chemotherapy did not increase risk for hospitalization or death due to COVID-19 among women with gynecologic cancer, according to results presented at the virtual Society of Gynecologic Oncology Annual Meeting on Women’s Cancer.
In addition, immunotherapy — identified in a smaller study conducted last year as a potential risk factor for COVID-19-related death among women with gynecologic cancer — did not appear associated with elevated risk for hospitalization or death in this larger study.
These results allow providers to reassure women with gynecologic cancer that they can continue anticancer therapy, according to researcher Olivia D. Lara, MD, MS, gynecologic oncology fellow at NYU Langone Health.
However, researchers determined Black patients were more than twice as likely to require hospitalization due to the novel coronavirus.
“This finding highlights the need to better understand the risks of COVID-19 in vulnerable populations,” Lara said during a presentation.
Multiple studies suggested people with cancer are at greater risk for health complications due to the novel coronavirus because of older age, comorbidities and their immunocompromised state. Initial research also suggested higher mortality due to COVID-19 among people with cancer.
“These findings were limited by their heterogeneity, sample size and inability to generalize to all cancer types,” Lara said. “Additionally, gynecologic malignancies often were underrepresented in these large multi-institutional studies.”
Meanwhile, some women with gynecologic cancers expressed concern that chemotherapy may increase their risk for more severe illness should they be infected with COVID-19, Lara said.
Lara and colleagues conducted a retrospective cohort study to assess outcomes of 193 women (median age, 65 years; 46.6% white; 34.7% Black) with gynecologic cancer and COVID-19 infection treated at one of eight New York City-area hospitals between March and May 2020.
Most women had endometrial/uterine, ovarian or cervical cancers, never smoked (74.6%) and had a performance status of 0 or 1 (76.7%). Mean BMI in the cohort was 31.6 kg/m2.
The rate of hospitalization and mortality due to COVID-19 served as the primary outcome measure.
Secondary objectives included determining the associations between anti-cancer treatment and COVID-19 infection severity; immunotherapy use and COVID-19 outcomes; gynecologic cancer stage and COVID-19 outcomes; and comorbidities and COVID-19 outcomes.
Researchers defined mild COVID-19 as manageable on an outpatient basis. They defined moderate disease as cases in which hospitalization was required. Those with severe disease required ICU admission or invasive mechanical ventilation or died due to COVID-19.
Eighty-seven women (45%) had mild COVID-19; 67 (34.7%) had moderate disease and 39 (20.2%) had severe disease.
Lara and colleagues found no statistically significant association between cancer type or stage and COVID-19 infection severity.
The most common presenting symptoms of COVID-19 in the cohort included fever (51.3%), cough (48.7%) and shortness of breath (37.8%), and women who presented with these symptoms were more likely to require hospitalization. In contrast, anosmia (4.7%) was associated with mild COVID-19 infection managed on an outpatient basis.
The most common comorbidities observed in the overall cohort included hypertension, diabetes and chronic kidney disease. More than half of women with moderate (53.7%) or severe (53.7%) COVID-19 had at least three comorbidities, compared with about one-third (31%) of those with mild COVID-19.
Sixty-one percent of women received cancer-directed therapy. Thirty percent received chemotherapy and 10% received targeted therapy. Other treatments included immunotherapy, surgery, hormone therapy and radiotherapy.
More than half (54.9%; n = 106) of the women in the cohort required hospitalization due to COVID-19; of these women, 39 (36.8%) required ICU admission and 13 (12.3%) required mechanical ventilation. Upon hospitalization, 72% of women required respiratory intervention. No women who required invasive ventilation were successfully extubated, Lara said.
Thirty-four women (17.6%) died due to COVID-19, 14 (7.2%) recovered with complications, 10 (5.1%) had ongoing infection at the time of study conclusion, and 135 (69.9%) recovered with no complications.
Among the women who died, 13 (38.2%) had received chemotherapy, four (11.8%) received immunotherapy, two (5.8%) had undergone surgery, two (5.8%) received targeted therapy, one (2.9%) had received hormone therapy and none received radiotherapy.
Multivariate analysis showed cytotoxic chemotherapy did not predict risk for COVID-19 hospitalization (OR = 0.83; 95% CI, 0.41-1.68) or death (OR = 1.56; 95% CI, 0.67-3.53).
Researchers also observed no significant association between immunotherapy receipt and risk for hospitalization or death due to COVID-19, contradicting a finding of a previous analysis based on the first 121 patients evaluated.
Researchers identified several factors associated with COVID-19 hospitalization, including age 65 years or older (OR = 2.12; 95% CI, 1.11-4.07), Black race (OR = 2.53; 95% CI, 1.24-5.32), performance status of 2 or higher (OR = 3.67; 95% CI, 1.25-13.55), and presence of three or more comorbidities (OR = 2; 95% CI, 1.05-3.84).
History of smoking appeared significantly associated with COVID-19 mortality (OR = 2.75; 95% CI, 1.21-6.22). Researchers observed no association between COVID-19 mortality and age, race, performance status, recent chemotherapy or comorbidities.
“Going forward, the impact of the COVID-19 pandemic on cancer care delivery and cancer screening must be evaluated,” Lara said. “Data collection is ongoing, with additional analyses and studies planned to investigate the impact COVID-19 has had on gynecologic cancer care through the [Society of Gynecologic Oncology] registry.”
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Lara OD, et al. Abstract 10663. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (virtual meeting); March 19-25, 2021.
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