Chemotherapy does not increase COVID-19 risk vs. noncytotoxic therapies for breast cancer
The COVID-19 pandemic has had a substantial impact on the delivery of cancer care.
Concerns about increased risk for COVID-19 among immunocompromised patients have prompted some clinicians to adapt or defer cancer treatments, such as cytotoxic chemotherapy.
However, these concerns may be unwarranted, according to findings scheduled for presentation during the virtual ASCO Annual Meeting.
Researchers at Perlmutter Cancer Center at NYU Langone Health found that among patients with breast cancer, chemotherapy does not increase COVID-19 risk any more than breast cancer treatments that do not impact the immune system.
“Our findings should reassure patients that, with use of infection precautions, therapies with established efficacy, including cytotoxic treatments, can be safely administered as per evidence-based guidelines,” study lead investigator Douglas Marks, MD, medical oncologist at Perlmutter Cancer Center and assistant professor at NYU Long Island School of Medicine, said in an interview with Healio.
Additionally, the study showed no increase in COVID-19 mortality risk among patients with breast cancer who received chemotherapy vs. noncytotoxic therapies, such as endocrine and/or HER2-directed therapy. Consistent with previous findings, older patients and those with overweight appeared at increased risk for death due to COVID-19.
Marks spoke with Healio about the study results and how they can guide patients and clinicians in making breast cancer treatment decisions.
Healio: What inspired you to conduct this study?
Marks: This study was inspired by conversations I was having daily with my patients in the exam room. Patients are concerned about whether cancer treatment impacts their risk for COVID-19 and how it might affect their outcomes if they were to develop COVID-19. Initial data from studies did suggest that patients with cancer were at higher risk for poor outcomes following COVID-19 infection. However, those studies included patients with many types of cancers and treatment histories. Cancer physicians know that oncology patients are a diverse group with different experiences with infection or risk for infection. This study aimed to assess risk specifically for patients with breast cancer and, in turn, to enable clinicians to accurately counsel this patient population.
Healio: How did you conduct the study?
Marks: We were interested in looking not only at outcomes of patients who got infected, but also their risk for infection. We looked at data of 3,039 patients (mean age, 62 years; range, 23-104) with breast cancer who received treatment at one of our cancer center locations in Manhattan, Long Island or Brooklyn during the peak of the pandemic. We looked at incidence of COVID-19 in the whole group, and then by treatment received, specifically exposure to cytotoxic chemotherapy vs. noncytoxic therapy, which was largely endocrine/HER2-directed treatment (E/H). Our primary endpoint was incidence of SARS-CoV-2 infection by treatment type, comparing cytotoxic chemotherapy with E/H. Morbidity and mortality of COVID-19 by treatment type served as secondary endpoints.
Healio: What did you find?
Marks: During the study we tested 641 patients, and 64 (2.1%) were diagnosed with COVID-19. That’s in the context of testing a little more than 20% of the patients. So, right off the bat, I think the low rate of COVID-19 infection observed confirms the efficacy of infection prevention measures. For the primary study aim, we found no statistically significant difference in risk for COVID-19 infection between patients who received chemotherapy and those who did not. Those treated with cytotoxic chemotherapy had a 3.5% weighted risk for SARS-CoV-2 infection vs. 2.7% among patients treated with E/H.
Among the 27 deaths during follow-up, 10 were associated with SARS-CoV-2 infection. One oncologic parameter — having stage IV disease — was associated with risk for death following infection. We also identified age, weight and Charlson Comorbidity Index as nononcologic factors associated with increased risk for COVID-19-associated mortality.
Healio: In addition to the reassurance these data can provide patients, how might these findings help clinicians?
Marks: I expect that this study will primarily be helpful to oncologists when counseling patients regarding the safety of receiving treatment in the context of a pandemic. Patients like to be able to have confidence in what their physician is saying, and having these data to reference during these conversations can be valuable. It is important to note that this was a real-world study, and although patients overall did very, very well, each patient is an individual and should be treated as such. Additionally, given the potential for emerging variants of COVID-19 in the future, it will be important to continue to monitor the impact of emerging variants among patients with breast cancer.
For more information:
Douglas Marks, MD, can be reached at Perlmutter Cancer Center at NYU Langone Health, 120 Mineola Blvd., Suite 500, Mineola, NY 11501.
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Budhathoki N, et al. Scheduled for presentation at: ASCO Annual Meeting (virtual meeting); June 4-8, 2021.