Study Finds Increased Risk for Death Following Chemo Use in Patients with Thoracic Cancer, COVID-19

Chemotherapy use in patients with lung and other thoracic cancers who are also diagnosed with the coronavirus 2019 (COVID-19) is associated with an increased risk of death compared to other treatment methods, according to an analysis presented as part of the virtual scientific program of the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting.

Previous research has found higher mortality rates in patients with cancer who are infected with COVID-19. Patients with lung or other thoracic malignancies, which include lung cancer, mesothelioma, thymic neoplasms, and carcinoid tumors, are considered to be at a higher risk of contracting the virus due to their, age, comorbidities, pre-existing lung damage, combined with cancer treatment that may compromise the immune system. 

A higher mortality rate had also been suggested in data from earlier studies on COVID-19 and this patient population, and so, to further examine the impact of a COVID-19 diagnosis on these individuals, researchers created an international database, named the Thoracic cancERs international coVid 19 cOLlaboraTion (TERAVOLT) registry. 

The initial goal was to collect data on patients with thoracic cancers diagnosed with COVID-19, to determine the demographic factors, comorbidities, cancer characteristics and therapies that put patients at a greater risk for hospitalization and death, and to provide practitioners with real-time data on the therapeutic strategies that may impact the survival of their patients.

Oncologists from around the world were then invited to enter their data, the results of which were presented during a presscast ahead of the ASCO Annual Meeting. 

As of data cut off on May 8, 400 patients were included in the analysis, the majority of which had stage IV cancer. Of the total, 169 patients have recovered, 141 have died, and 118 are still currently in treatment. In all groups, the average age was between 66.5 and 70, while the majority of patients were males with non-small cell lung cancer (NSCLC). A small percentage of all groups were never smokers.

Of the 141 individuals who died, 79.4% (112) died due to COVID-19, 10.6% (15) died of cancer, while 8.5% (12) died as a result of both cancer and COVID-19. Two deaths were determined to be from unknown reasons. 

In the presscast, lead author Leora Horn, MD, who is the Ingram Associate Professor of Cancer Research and the Director of the Thoracic Oncology Program at Vanderbilt University Medical Center, went on to explain that, in the 3 months prior to COVID-19 diagnosis, a significant number of patients who later died (45%) were on chemotherapy, while 20% of patients who died were on immunotherapy, and even smaller percentages were on targeted or radiation therapies. The majority of patients were either untreated, or on the first line of treatment, at the time of COVID-19 infection. 

Only the patients treated with chemotherapy within 3 months of their COVID-19 diagnosis, either alone or in combination with other therapies, had a significantly increased risk (64%) of dying from the virus, versus patients who did not receive chemotherapy. 

Of the total 400 patients in the database, 334 were admitted to the hospital, and 20 were placed on mechanical ventilation. The median length of hospitalization was 10 days. 

While being 65 or older and having comorbidities are both risk factors associated with mortality, corticosteroid and anticoagulant treatment also pose a risk, but further study is needed. 

The researchers noted that the type of COVID-19 treatment did not appear to be a factor in the risk of death, as the number of patients who died after receiving anticoagulants, antibiotics, antivirals, antifungals, corticosteroids, drugs targeting IL-6, and hydroxychloroquine was the same or similar to the number of patients that recovered. 

While these findings offer a better understanding of the risk factors associated with poor outcomes in patients with thoracic cancer who develop COVID-19, the researchers did note that the database is a fluid tool that is constantly evolving as information on COVID-19 is discovered. 

“A number of factors - pre-existing lung damage, smoking status, advanced age, and comorbidities - make patients with thoracic cancers especially vulnerable to COVID-19,” said ASCO President Howard A. Burris III, MD, FACP, FASCO, in a press release about the data. “There are a lot of questions right now, and not a lot of answers. These findings give us some insights into outcomes for patients with cancer who develop COVID-19.”  

Reference: 

Horn L, Whisenant J, Torri V, et al. Latest global research on COVID-19 in patients with thoracic cancer examining the impact of specific cancer treatments on outcomes. Presented at: 2020 ASCO Virtual Scientific Program; May 26, 2020. LBA111.