|Summary of Select Studies on COVID-19 Infection and Outcomes Among Patients With Cancer Data|
|Study||Country/Countries||Cancer Types||Number of Patients With COVID-19||aOR of SARS-CoV-2 Infection (95% CI)||Hospitalization Rate, %||Mortality Rate, %|
|Wang et al.|
|U.S.||All cancer||1200||1.46 (1.42–1.50)||—||—|
|Recent (i.e., past 12 mo) cancer diagnosis||670||7.14 (6.91–7.39)||48||15|
|Recent lung cancer diagnosis||100||7.66 (7.07–8.29)||—||—|
|Control (COVID-19, no cancer)||14,840||24||5|
|Aschele et al.|
|Italy||All cancer (active anticancer treatment)||406||1.42 (1.29–1.56)||77||—|
|Lung cancer (active anticancer treatment)||91||—||—||—|
|Control (COVID-19, general population)||—||—||—||—|
|Grivas et al.|
|95% in U.S.||All cancer||4966||—||58||14|
|Rivera et al.|
|Kuderer et al.|
|Pinato et al.||UK, Italy, Spain,and Germany||All cancer||890||—||—||34|
|Lee et al.|
|Respiratory and intrathoracic organs||90||—||—||36|
|Mehta et al.||U.S.||All cancer||218||—||—||28|
|Control (COVID-19, no cancer)||1090||—||—||14|
|Garassino et al.7||Mostly Italy, Spain, and France||Thoracic cancer||200||76||33|
|Luo et al.||U.S.||Lung cancer||102||—||62||25|
|Tagliamento et al.|
|Global metadata||All cancer||33,879||—||—||25|
- -Wang et al.3: Any death during the study period (August 2019–August 2020), death imported from the Social Security Death Index.
- -Grivas et al.42: All-cause mortality within 30 days of COVID-19 diagnosis.
- -Rivera et al.77: 30-Day all-cause mortality.
- -Kuderer et al.43: All-cause mortality within 30 days of COVID-19 diagnosis.
- -Pinato et al.
- -Lee et al.44: All-cause mortality during the study period (March 18, 2020–April 26, 2020).
- -Mehta et al.
- -Garassino et al.7: All-cause mortality; of the 66 patients who died, 52 were due to COVID only, seven due to cancer only, three due to cancer and COVID, one due to complication from cancer therapy, one due to cancer progression and another unstated reason, and two due to unstated reasons.
- -Luo et al.
- -Tagliamento et al.4: Rate of death (i.e., case fatality rate) within the study population.
Biological Context: COVID-19 and Lung Cancer
Clinical Implications of COVID-19 for Patients With Lung Cancer
COVID-19 Implications for Lung Cancer Diagnosis
- Iadevaia C.
- Perrotta F.
- Mazzeo G.
- et al.
Impact of Cancer Therapy on SARS-CoV-2 Infection
|Summary of Select Studies Exploring the Impact of Cancer Treatments on COVID-19 Severity|
|Study||Country/Countries||Cancer Types||Number of Patients With COVID-19||Key Insights|
|Grivas et al.|
|95% in U.S.||All cancer||4966||Recent (past 3 mo) cytotoxic chemotherapy associated with severe COVID-19 (OR = 1.28) and 30-d mortality (OR = 1.61). Noncytotoxic anticancer therapies, including immunotherapy, targeted therapy, and endocrine therapy not associated with severe COVID-19 nor 30-d mortality|
|Kuderer et al.|
|U.S.||All cancer||928||No association between 30-d all-cause mortality and recent surgery, recent noncytotoxic therapy, or recent cytotoxic systemic therapy|
|Pinato et al.||UK, Italy, Spain, and Germany||All cancer||890||No association between cytotoxic chemotherapy, targeted therapy, or immunotherapy and COVID-19 severity|
|Lee et al.|
|UK||All cancer||800||No significant mortality effect for recent (past 4 wk) chemotherapy, immunotherapy, hormonal therapy, targeted therapy, or radiotherapy|
|Respiratory and intrathoracic organs||90|
|Mehta et al.||U.S.||All cancer||218||Neither chemotherapy nor radiotherapy associated with|
|Lung||11||increased case fatality rate|
|Garassino et al.|
|Mostly Italy, Spain, and France||Thoracic cancer||200||In multivariable analysis, TKIs, chemotherapy, and immunotherapy, not associated with increased mortality|
|Luo et al.||U.S.||Lung cancer||102||No observed impact of TKIs or chemotherapy and COVID-19 severity|
|Luo et al.|
|U.S.||Lung cancer||69||No significant association between PD-1 blockade and COVID-19 severity|
COVID-19 Vaccine Safety and Efficacy in Patients With Lung Cancer
Cancer groups urge CDC to prioritize cancer patients for COVID-19 vaccination.
|Summary of COVID-19 Vaccine Effectiveness in Fully Vaccinated Patients With Cancer|
|Study||Country/Countries||Cancer Types||# of Patients or Control||Vaccine||# of Patients or Control||% Seroconversion||Median Titer Level (AU/mL or U/mL)|
|Gounant et al.||France||Thoracic||269||Mostly BNT162b2||269||94||4725|
|Goshen-Lago et al.|
|Massarweh et al.|
|Thakkar et al.|
|Thoracic/head and neck||25||mRNA-1273||62||94||11,963|
|Addeo et al.|
|Barriere et al.|
|Monin et al.|
- Gounant V.
- Ferré V.M.
- Soussi G.
- et al.
COVID vaccines slash viral spread—but delta is an unknown.
- Nasreen S.
- He S.
- Chung H.
- et al.
- Gilbert P.B.
- Montefiori D.C.
- McDermott A.
- et al.
COVID-19 Impact on Lung Cancer Research
- Gounant V.
- Ferré V.M.
- Soussi G.
- et al.
Information on third mRNA COVID-19 vaccine dose added to NCCN guidance for people with cancer.
CRediT Authorship Contribution Statement
- The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.Lancet Oncol. 2020; 21: 1023-1034
- Incidence of SARS-CoV-2 infection among patients undergoing active antitumor treatment in Italy.JAMA Oncol. 2021; 7: 304-306
- Analyses of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection.JAMA Oncol. 2021; 7: 220-227
- Mortality in adult patients with solid or hematological malignancies and SARS-CoV-2 infection with a specific focus on lung and breast cancers: a systematic review and meta-analysis.Crit Rev Oncol Hematol. 2021; 163: 103365
- Current perspectives for SARS-CoV-2 vaccination efficacy improvement in patients with active treatment against cancer.Eur J Cancer. 2021; 154: 66-72
- COVID-19 in patients with lung cancer.Ann Oncol. 2020; 31: 1386-1396
- COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study.Lancet Oncol. 2020; 21: 914-922
- The impact of angiotensin-converting enzyme 2 (ACE2) expression levels in patients with comorbidities on COVID-19 severity: a comprehensive review.Microorganisms. 2021; 9: 1692
- Elevated expression of ACE2 in tumor-adjacent normal tissues of cancer patients.Int J Cancer. 2020; 147: 3264-3266
- Overexpression of the SARS-CoV-2 receptor ACE2 is induced by cigarette smoke in bronchial and alveolar epithelia.J Pathol. 2021; 253: 17-30
- Expression and clinical significance of SARS-CoV-2 human targets in neoplastic and non-neoplastic lung tissues.Curr Cancer Drug Targets. 2021; 21: 428-442
- The mechanisms and animal models of SARS-CoV-2 infection.Front Cell Dev Biol. 2021; 9: 578825
- Oncolytic viruses—interaction of virus and tumor cells in the battle to eliminate cancer.Front Oncol. 2017; 7: 195
- Inflammatory profiles across the spectrum of disease reveal a distinct role for GM-CSF in severe COVID-19.Sci Immunol. 2021; 6eabg9873
- The dysregulated innate immune response in severe COVID-19 pneumonia that could drive poorer outcome.J Transl Med. 2020; 18: 457
- Hallmarks of cancer: the next generation.Cell. 2011; 144: 646-674
- The basics of epithelial-mesenchymal transition.J Clin Invest. 2009; 119: 1420-1428
- Microenvironmental regulation of metastasis.Nat Rev Cancer. 2009; 9: 239-252
- Transitions between epithelial and mesenchymal states: acquisition of malignant and stem cell traits.Nat Rev Cancer. 2009; 9: 265-273
- Pulmonary fibrosis secondary to COVID-19: a narrative review.Expert Rev Respir Med. 2021; 15: 791-803
- Risk factors and clinical characteristics of lung cancer in idiopathic pulmonary fibrosis: a retrospective cohort study.BMC Pulm Med. 2019; 19: 149
- Impact of the COVID-19 pandemic on lung cancer screening program and subsequent lung cancer.J Am Coll Surg. 2021; 232: 600-605
- Management of lung nodules and lung cancer screening during the COVID-19 pandemic: CHEST expert panel report.Radiol Imaging Cancer. 2020; 2e204013
- Impact of the COVID-19 pandemic on cancer clinical trials.Ann Surg Oncol. 2021; 28: 7311-7316
- FP13.03 the impact of the COVID-19 pandemic on lung cancer screening programs in the United States.J Thorac Oncol. 2021; 16 (S969–S969)
Fedewa SA, Bandi P, Smith RA, Silvestri GA, Jemal A. Lung cancer screening rates during the COVID-19 pandemic [e-pub ahead of print]. Chest. https://doi.org/10.1016/j.chest.2021.07.030, accessed October 19, 2021.
- Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic.JAMA Netw Open. 2020; 3e2017267
- Association of cancer screening deficit in the United States with the COVID-19 pandemic.JAMA Oncol. 2021; 7: 878-884
- Collateral effects of the coronavirus disease 2019 pandemic on lung cancer diagnosis in Korea.BMC Cancer. 2020; 20: 1040
- 35P Lung cancer diagnosis and continuum of care: how did the COVID-19 outbreak impact? Data from an Italian multicenter study.J Thorac Oncol. 2021; 16: S713
- Effect of COVID-19 on thoracic oncology surgery in Spain: a Spanish Thoracic Surgery Society (SECT) survey.Cancers (Basel). 2021; 13: 2897
- Challenges in management of patients with lung cancer in times of COVID-19: an imaging perspective.Clin Lung Cancer. 2020; 21: 568-570
- COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study.Transl Lung Cancer Res. 2020; 9: 1516-1527
- Coronavirus disease 2019 or lung cancer: a differential diagnostic experience and management model from Wuhan.J Thorac Oncol. 2020; 15: e141-e142
- The impact of COVID-19 on systemic anticancer treatment delivery in Scotland.Br J Cancer. 2021; 124: 1353-1356
- The effect of clinical decision making for initiation of systemic anticancer treatments in response to the COVID-19 pandemic in England: a retrospective analysis.Lancet Oncol. 2021; 22: 66-73
- Incidental diagnosis of lung adenocarcinoma following coronavirus OC 43 severe pneumonia.Monaldi Arch Chest Dis. 2020; 90https://doi.org/10.4081/monaldi.2020.1313
- Inequalities in the decline and recovery of pathological cancer diagnoses during the first six months of the COVID-19 pandemic: a population-based study.Br J Cancer. 2021; 125: 798-805
- Impact of the COVID-19 pandemic on cancer care: a global collaborative study.JCO Glob Oncol. 2020; 6: 1428-1438
- Impact of COVID-19 pandemic on lung cancer treatment scheduling.Thorac Cancer. 2020; 11: 2983-2986
- Impact of PD-1 blockade on severity of COVID-19 in patients with lung cancers.Cancer Discov. 2020; 10: 1121-1128
- Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium.Ann Oncol. 2021; 32: 787-800
- Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study.Lancet. 2020; 395: 1907-1918
- COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study.Lancet Oncol. 2020; 21: 1309-1316
- Clinical portrait of the SARS-CoV-2 epidemic in European cancer patients.Cancer Discov. 2020; 10: 1465-1474
- Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine.N Engl J Med. 2020; 383: 2603-2615
- Challenges and opportunities for COVID-19 vaccines in patients with cancer.Cancer Invest. 2021; 39: 205-213
- Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine.N Engl J Med. 2021; 384: 403-416
- Serologic status and toxic effects of the SARS-CoV-2 BNT162b2 vaccine in patients undergoing treatment for cancer.JAMA Oncol. 2021; 7: 1507-1513
- Evaluation of seropositivity following BNT162b2 messenger RNA vaccination for SARS-CoV-2 in patients undergoing treatment for cancer.JAMA Oncol. 2021; 7: 1133-1140
- Seroconversion rates following COVID-19 vaccination amongst patients with cancer.Cancer Cell. 2021; 39: 1081-1090.e2
- Immunogenicity of SARS-CoV-2 messenger RNA vaccines in patients with cancer.Cancer Cell. 2021; 39: 1091-1098.e2
- Safety and immunogenicity of one versus two doses of the COVID-19 vaccine BNT162b2 for patients with cancer: interim analysis of a prospective observational study.Lancet Oncol. 2021; 22: 765-778
- Short-term safety of the BNT162b2 mRNA COVID-19 vaccine in patients with cancer treated with immune checkpoint inhibitors.Lancet Oncol. 2021; 22: 581-583
- Cancer groups urge CDC to prioritize cancer patients for COVID-19 vaccination.(Accessed October 19, 2021)
- Concomitant medications during immune checkpoint blockage in cancer patients: novel insights in this emerging clinical scenario.Crit Rev Oncol Hematol. 2019; 142: 26-34
- Durability of response to SARS-CoV-2 BNT162b2 vaccination in patients on active anticancer treatment.JAMA Oncol. 2021; 7: 1716-1718
- Six month efficacy and toxicity profile of BNT162b2 vaccine in cancer patients with solid tumors.Cancer Discov. 2021; 11: 2430-2435
- Immune responses to two and three doses of the BNT162b2 mRNA vaccine in adults with solid tumors.Nat Med. 2021; 27: 2002-2011
- LBA8 Vaccination against SARS-CoV-2 in patients receiving chemotherapy, immunotherapy, or chemo-immunotherapy for solid tumors.Ann Oncol. 2021; 32: S1337
- Efficacy of SARS-CoV-2 vaccine in thoracic cancer patients: a prospective study supporting a third dose in patients with minimal serologic response after two vaccine doses. medRxiv.J Thorac Oncol. 2022; 17: 239-251https://doi.org/10.1016/j.jtho.2021.10.015
- Effectiveness of COVID-19 vaccines against the B.1.617.2 (delta) variant.N Engl J Med. 2021; 385: 585-594
- COVID vaccines slash viral spread—but delta is an unknown.Accessed October 19, 2021)
- Effectiveness of COVID-19 vaccines against variants of concern, Canada. medRxiv.(Accessed October 19, 2021)
- Public Health Scotland and the EAVE II Collaborators. SARS-CoV-2 delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness.Lancet. 2021; 397: 2461-2462
- A correlate of protection for SARS-CoV-2 vaccines is urgently needed.Nat Med. 2021; 27: 1147-1148
- Neutralizing antibody levels are highly predictive of immune protection from symptomatic SARS-CoV-2 infection.Nat Med. 2021; 27: 1205-1211
- Evidence for antibody as a protective correlate for COVID-19 vaccines.Vaccine. 2021; 39: 4423-4428
- Immune correlates analysis of the mRNA-1273 COVID-19 vaccine efficacy trial. medRxiv.(Accessed October 19, 2021)
- Covid-19 breakthrough infections in vaccinated health care workers.N Engl J Med. 2021; 385: 1474-1484
- OA01.01—analysis of lung cancer patients receiving SARS-CoV-2 vaccines revealed a minority subset with poor antibody responses relative to controls.J Thorac Oncol. 2021; 16: S848
- Early impact of COVID-19 on the conduct of oncology clinical trials and long-term opportunities for transformation: findings from an American Society of Clinical Oncology survey.JCO Oncol Pract. 2020; 16: 417-421
- Association of the coronavirus disease 2019 (COVID-19) outbreak with enrollment in cancer clinical trials.JAMA Netw Open. 2020; 3e2010651
- PL02.09 International Association for the Study of Lung Cancer (IASLC) study of the impacts of COVID-19 on International Lung Cancer Clinical Trials.J Thorac Oncol. 2020; 16: S847-S848
- American Society of Clinical Oncology Road to Recovery Report: learning from the COVID-19 experience to improve clinical research and cancer care.J Clin Oncol. 2021; 39: 155-169
- Information on third mRNA COVID-19 vaccine dose added to NCCN guidance for people with cancer.(Accessed October 19, 2021)https://www.nccn.org/home/news/newsdetails?NewsId=2867&fbclid=IwAR1smOyfRqs1UTHid1EbKAyRg4Ug_2tFWXp_FMdSzWEXxhmEraZaP14TPsE
- Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: a COVID-19 and Cancer Consortium (CCC19) cohort study.Cancer Discov. 2020; 10: 1514-1527
- Case fatality rate of cancer patients with COVID-19 in a New York Hospital system.Cancer Discov. 2020; 10: 935-941
Disclosure: Dr. Rolfo reports receiving funding from the Lung Cancer Research Foundation—Pfizer Grant 2019; personal fees for attending advisory board meetings from ArcherDx, Bristol-Myers Squibb, Boston Pharmaceuticals, Inivata, MD Serono, and Novartis; fees for speakers bureau from AstraZeneca, Merck Sharp & Dohme, and Roche; and nonfinancial support from Guardant Health through a research collaboration. Dr. Russo reports receiving personal fees for attending advisory board meetings from AstraZeneca, Merck Sharp & Dohme, and Novartis. The Icahn School of Medicine at Mount Sinai has filed patent applications relating to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic assays and NDV-based SARS-CoV-2 vaccines which list Dr. Krammer as coinventor. Mount Sinai has spun out a company, Kantaro, to market serologic tests for SARS-CoV-2. Dr. Krammer has consulted for Merck and Pfizer (before 2020) and is currently consulting for Pfizer, Third Rock Ventures, Seqirus, and Avimex. The Krammer laboratory is also collaborating with Pfizer on animal models of SARS-CoV-2. Dr. García-Sastre reports receiving funding from the National Institutes of Health, National Cancer Institute (NCI) U54CA260560 and National Institutes of Health, National Institute of Allergy and Infectious Diseases 75N93019R00028; having royalties or licenses from Avimex and Medimmune; receiving consulting fees from 7Hills Pharma, Avimex, Esperovax, Farmak, Applied Biological Laboratories, Pharmamar, and Pfizer; having speakers bureau for Sequirus; having patents planned, issued, or pending for use of NDV as vaccine vector for coronavirus disease 2019; participating at the advisory board for coronavirus disease 2019 vaccines in the New York State; and having stock options in Vivaldi Biosciences, Contrafect, and Pagoda. Dr. Mack reports receiving funding from NCI U54CA260560 grant and speakers bureau from Guardant Health and Amgen. Dr. Gomez reports receiving funding from NCI U54CA260560 grant and personal fees for attending advisory board meetings from Bristol-Myers Squibb. Dr. Bhardwaj is an extramural member of the Parker Institute for Cancer Immunotherapy; receives research funds from Regeneron, Harbor Biomedical, and Dragonfly Therapeutics; and is on the advisory boards of Neon Therapeutics, Novartis, Avidea, Boehringer Ingelheim, Rome Therapeutics, Roswell Park Comprehensive Cancer Center, BreakBio, Carisma Therapeutics, Rubio, CureVac, Genotwin, BioNTech, Gilead and Tempest Therapeutics, and the Cancer Research Institute. Dr. Sirera reports receiving support from Merck Sharp & Dohme for attending meetings, having honoraria, and conducting lectures. Dr. Moore reports receiving unpaid participation in the NTRKers Board of Directors. Dr. Rohs reports receiving institutional grant support from U54 Grant; receiving personal consulting fees from AstraZeneca, Genentech, and BeiGene; having speakers bureau from PER/OncLive; participating on the Mount Sinai Data Safety and Monitoring Committee; and being the founder of the New York Lung Cancer Foundation. Dr. Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on computed tomography scans of the chest which are owned by the Cornell Research Foundation (CRF). Since 2009, Dr. Henschke does not accept any financial benefit from these patents, including royalties, and any other proceeds related to the patents or patent applications owned by CRF. Dr. Henschke is the President and serves on the board of the Early Diagnosis and Treatment Research Foundation and receives no compensation from the Foundation. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Recipients include I-ELCAP, among others. The funding comes from a variety of sources, including philanthropic donations, grants, and contracts with agencies (federal and nonfederal), imaging, and pharmaceutical companies relating to image processing assessments. The various sources of funding exclude any funding from tobacco companies or tobacco-related sources. Dr. Yankelevitz reports receiving consulting fees from AstraZeneca, Pfizer, and Genentech; being a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest, including measurement of nodules, in which some of these, which are owned by CRF, are nonexclusively licensed to General Electric; serving on the medical advisory board of Carestream; and being an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision-making. Dr. King reports receiving funding support from NCI Seronet U54 Funding to Mount Sinai School of Medicine (subcontract to GO2 Foundation for Lung Cancer); receiving grants from Bristol-Myers Squibb and Genentech for scientific research projects funding paid to GO2 Foundation for Lung Cancer; having speakers bureau (paid to GO2 Foundation for Lung Cancer) from AstraZeneca, Foundation Medicine, Merck, and Thermo Fisher Scientific; and participating on a data safety monitoring board or advisory board (paid to GO2 Foundation for Lung Cancer) from Boehringer Ingelheim and Guardant. Dr. Shyr reports receiving funding support from the National Institutes of Health (P30CA068485; U24CA163056; U24CA213274; P50CA236733; P50CA098131; U54CA163072); receiving grants or contracts from the National Institutes of Health (P30CA068485; U24CA163056; U24CA213274; P50CA236733; P50CA098131; U54CA163072); having speakers bureau from Roche, AstraZeneca, and Eisai; and participating on a data safety monitoring board or advisory board from Novartis, Pfizer, Janssen (Johnson & Johnson), AstraZeneca, and Roche. Dr. Bunn reports receiving consulting fees from Bristol-Myers Squibb, Ascentage, Merck, CStone, AstraZeneca, Eli Lilly, Ipsen, and Verastem; participating on a data safety monitoring board or advisory board from Merck and Bristol-Myers Squibb; and having leadership role in Verastem. Dr. Minna reports receiving funding support from the National Cancer Institute. Dr. Hirsch reports receiving grant support from NCI U54CA260560; participating in scientific advisory boards for Amgen, AstraZeneca, Bristol-Myers Squibb, Daiichi, Genentech/Roche, Merck, Novartis, OncoCyte, Pfizer, Regeneron, and Sanofi; receiving payment for expert testimony from GLG; and being an investigator in a University of Colorado–owned patent: “EGFR protein expression and EGFR high copy number as predictive biomarker for EGFR directed therapy.” The remaining authors declare no conflict of interest.
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