COVID-19 May Be Associated with High Burden of Severity in Patients with Lung Cancer

A recent analysis found that the coronavirus disease 2019 (COVID-19) is associated with high burden of severity in patients with lung cancer.

The study, published in Annals of Oncology, also suggested that patient-specific features, rather than cancer-specific features or treatments, are the greatest determinants of severity in this patient population.

“Our results characterize COVID-19 in patients with lung cancers, highlighting both the urgent vulnerability of patients with lung cancer during this pandemic as well as the persistently critical need to continue, and drive improvements in, optimal cancer care,” the authors wrote.

Researchers examined 102 consecutive patients with lung cancer and a confirmed diagnosis of COVID-19 at a single center from March 12 to May 6, 2020. Thresholds of severity were defined a priori as hospitalization, ICU/intubation/DNI (a composite metric of severe disease including ICU stay, intubation and invasive mechanical ventilation, and/or transition to do not intubate [DNI]), or death. Recovery was defined as >14 days from COVID-19 test and >3 days since symptom resolution.

In patients with lung cancer, COVID-19 was found to be particularly severe (62% hospitalized, 25% died). However, although severe, COVID-19 accounted for a minority of overall lung cancer deaths during the pandemic (11% overall).

“This finding amplifies the importance of maintaining urgent focus on the needs of patients with cancer and optimizing cancer care within the context of the local prevalence of SARS-CoV-2 infection,” the authors wrote.

Notably, the course of infection in patients with lung cancer was longer and more severe than what has been reported thus far in the general US population. Approximately a third of patients experienced a milder outpatient course, two thirds required hospitalization, and a quarter died.

Determinants of COVID-19 severity were generally patient-specific features, including smoking status and chronic obstructive pulmonary disease: Those with a median 23.5 pack-years demonstrated higher odds, compared with never smokers ([OR, 2.9; 95% CI, 1.07-9.44] vs [OR, 3.87; 95% CI, 1.35-9.68]). Additionally, cancer-specific features, including prior thoracic surgery/radiation and recent systemic therapies, did not impact severity.

“Our findings suggest that risk factors leading to lung cancer and its related chronic medical conditions, rather than cancer itself or cancer-directed treatments, are the primary drivers of severity of COVID-19 in patients with lung cancers,” the authors wrote.

Moreover, HLA supertypes were largely similar in mild or severe cases of COVID-19 compared to non-COVID-19 controls. However, the investigators suggested that future studies with larger sample sizes will be necessary to precisely define the impact of HLA alleles on the severity of COVID-19.

Most patients studied recovered from COVID-19, including 25% patients who initially required intubation. Even further, absence of COPD, absence of CHF, and fewer pack-years smoked were predictors of attaining recovery.

Importantly, consistent with previously published data, hydroxychloroquine did not improve COVID-19 outcomes among hospitalized patients.

Given the smaller sample size of this study, which affects the ability to perform adjustments for multiple possible confounders, researchers indicated that larger sample sizes and cohorts are needed to affirm the generalizability of these results.

Reference:

Luo J, Rizvi H, Preeshagul IR, et al. COVID-19 in patients with lung cancer. Annals of Oncology. doi:10.1016/j.annonc.2020.06.007