Clinical factors and recent anti-cancer therapies associated with COVID-19 severity in cancer patients

April 2021 Science Tobias Rawson

Cancer patients have a greater risk of mortality from COVID-19 compared to the general population. However, research is still ongoing to identify specific risk factors in these patients associated with COVID-19 prognosis. Recently published data from the COVID-19 and Cancer Consortium indicate that certain clinical features and specific prior anti-cancer treatments are associated with a more severe COVID-19 disease course.

Expert opinion

Commenting on these findings, Dr. Lybaert underscores that “every oncologist has been challenged by the COVID-19 crisis during the last year. For now, it seems that this challenge will remain present in the coming months. Studies have indicated that patients with haematological malignancies are at a higher risk for severe COVID-19 compared to patients with solid tumors. Nevertheless, also patients with solid tumors represent an at-risk population for a severe COVID-19 course. Across all these studies, age and the presence of comorbidities are consistently identified as the most important risk factors for complications following a COVID-19 infection. Vaccination for all our oncological patients will be key in the next months.”

Introduction

Cancer patients with COVID-19 infection have an increased risk of mortality of approximately 13%-33%, compared to the general population (general mortality rate approximately 0.5-2%). Previous studies from the COVID-19 and Cancer Consortium (CCC19) have indicated that comorbidities, older age and worse performance status are associated with a worse COVID-19 prognosis. However, demographic characteristics, clinical factors such as specific prior treatments and laboratory measurements have not previously been investigated in relation to COVID-19 clinical outcomes. Investigating these factors, CCC-19 enrolled 4,966 patients with invasive cancer and a COVID-19 infection. Patient data were collected, and the clinical outcome of their COVID-19 infection was categorised into a five-level ordinal scale of severity. 30-day all-cause mortality was also analysed in relation to patterns of anti-cancer therapy these patients had previously received within 3 months of their COVID-19 diagnosis.

58% of cancer patients hospitalised with COVID-19

At a median follow-up of 42 days, 58% were hospitalised with COVID-19. The median age of the entire cohort was 66 years, while the median age of hospitalised patients was reported at 70 years. In both groups, approximately half were female. Overall, approximately 80% had solid tumours, 51% had cancer in remission and 40% had received anti-cancer therapy within 3 months of their COVID-19 diagnosis. In total, 2,072 patients had an uncomplicated disease course, while 2,894 patients did experience complications. Of these patients, 1,675 were admitted to hospital but did not require intensive care unit (ICU) escalation. In contrast, 232 patients did require an ICU admission, with a further 292 required ICU admission with mechanical ventilation. Overall, 695 died within 30 days. Patients who died were typically older, with a median age of 75 years. Additionally, more male patients received mechanical ventilation or died, indicating a worse clinical outcome for male patients. Generally, being over the age of 40, being male, non-Hispanic black or non-Hispanic white was associated with worse clinical outcomes. A more pronounced COVID-19 severity was also associated with obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, worse ECOG PS and haematological malignancies. Similarly, progressive cancer, recent cytotoxic chemotherapy were also associated with a higher severity of COVID-19 infection. Interestingly, this was not the case for immunotherapy, targeted therapy and endocrine therapy. Interestingly, the proportion of 30-day mortality was highest in the months January to April (21%), followed by May-August (10%), and September-November (7%).

In patients who were hospitalised, both high and low ALC, high ANC, low platelet count, abnormal creatinine, troponin, LDH and CRP were all associated with a higher severity of COVID-19 infection. 856 (53%) patients had been exposed to a single drug/drug class within 3 months of COVID-19 diagnosis, whilst 357 (22%) had received at least 3 drugs in combination. The drugs associated with the highest 30-day mortality included platinum-etoposide, R-CHOP-like and DNA methyltransferase inhibitor regimens.

Reference

Grivas P et al., Association of Clinical Factors and Recent Anti-Cancer Therapy with COVID-19 Severity among Patients with Cancer: A Report from the COVID-19 and Cancer Consortium. Annals of Oncol. 2021; S0923-7534(21)00874-7.

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