COVID-19 Increases Overall Risk for Death in Patients with Cancer

During the July 2020 AACR virtual meeting on COVID-19 and cancer, Solange Peters, MD, PhD, European Society for Medical Oncology President, and Head, Medical Oncology Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland, delivered the keynote address, providing an update on the COVID-19 and Cancer Consortium cohort study.

The recent data set from this study shows that the death rate in patients with cancer who have COVID-19 disease is 16%, which is approximately triple the rate of the general population, depending on the data source.

Currently, there are 2956 patients enrolled in the registry, which covers the United States, Canada, and South America. Dr Peters presented data on 2186 patients with invasive cancer and laboratory-confirmed COVID-19 disease (unpublished data at the time of the meeting) that were entered in the registry between March 17, 2020, and June 26, 2020.

“This is the third look at the COVID-19 and Cancer Consortium data,” Dr Peters said.

Risk Factors in Patients with Cancer

The overall mortality rate for all patients with cancer and confirmed COVID-19 included in the COVID-19 and Cancer Consortium cohort is 16% compared with a rate ranging from 2% to 7% in the general population of people who are infected with the novel coronavirus, depending on the geographic area and the study.

Several factors are accounting for an increase in the mortality rate of patients with cancer; these include progressing cancer, which accounts for 26% of the mortality rate; age >75 years, which accounted for 27% of the death rate; Eastern Cooperative Oncology Group (ECOG) performance status score of ≥2 accounted for 35% of the death rate; age >75 years plus intubation accounted for 64% of the death rate; and ECOG score ≥2 with intubation accounted for 75% of the mortality rate in patients with cancer.

Overall, 47% of the patients had mild COVID-19 disease, 40% had moderate disease, and 12% had severe disease.

A total of 51% of the patients in the registry were in remission from their cancer, 28% had stable disease or cancer that was responding to therapy, and 11% had actively progressing cancer.

Mortality-Related Results

The rates of mortality associated with specific types of cancer were:

  1. 26% for lung cancer
  2. 22% for lymphoma
  3. 19% for colorectal cancer
  4. 19% for plasma-cell dyscrasias
  5. 8% for breast cancer.

The rate of 30-day all-cause mortality (adjusted for age, sex, obesity, recent surgery, geographic region, ECOG performance status, and cancer status) was higher in older patients and in male patients (adjusted odds ratio [OR], 1.52 and 1.43, respectively).

The adjusted OR for non-Hispanic black patients was 1.56 versus non-Hispanic white patients. The adjusted OR for hematologic malignancy versus solid tumors was 1.80. The adjusted OR for patients with an ECOG score of 1 versus 0 was 1.80, and the adjusted OR for ECOG score ≥2 versus 0 was 4.2.

In patients with cancer that is in remission, the adjusted OR was 1.47 versus those with no evidence of malignancy. In patients with cancer that is progressing, the adjusted OR is 2.96 versus those whose cancer is in remission or those with no evidence of cancer.

Treatment for COVID-19

Among the 2186 patients enrolled in the database, 1321 did not receive any treatment for COVID-19; among the patients who received treatment for COVID-19, 69% were exposed to remdesivir, 5% received tocilizumab, and 41% to “other” treatments.

“Most patients were exposed to more than 1 treatment,” Dr Peters noted.

Patients with cardiovascular comorbidities and those living in the western United States were less likely to be exposed to hydroxychloroquine and doxorubicin and were more likely to receive remdesivir.

The analysis also showed that non-Hispanic black patients had reduced exposure to remdesivir compared with non-Hispanic white patients.

“Severe COVID-19 is, of course, correlated with higher exposure to treatment compared with mild and moderate COVID-19,” Dr Peters said.

“High-dose hydroxychloroquine given along with other treatments significantly increased 30-day all-cause mortality compared to other treatments, even when the most severely ill patients were excluded. Remdesivir alone was associated with decreased 30-day mortality compared with negative controls, while high-dose corticosteroids plus any other therapy was associated with increased 30-day mortality compared to negative controls,” she continued. “We did not see the benefit of corticosteroids shown in other series.”

Dr Peters stated, “Putting all of this in perspective, our findings strongly indicate that the role of emerging treatments requires formal prospective trials in the future.”

Key Takeaways

“We have learned humbling lessons from this crisis, and there were missed opportunities,” Dr Peters said.

Of utmost importance is not rushing to publish data without appropriate review. “The flood of preprints without undergoing peer review is a major source of concern. COVID-19 has ushered in a lack of appropriate review and editorial rigor, even among elite medical journals, notably regarding the expertise of reviewers,” she pointed out.

Going forward, Dr Peters called for international collaboration on prospective series and large, randomized trials.

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