Introduction
Patients with thoracic cancers (TC) have one of the highest rates of mortality among patients with cancer and COVID-19. Data evaluating the impact of recent anti-cancer therapies on COVID-19 outcomes in patients with TC are confined to small heterogenous retrospective studies, with limited follow-up data. We analyzed data from the COVID-19 and Cancer Consortium (CCC19) (NCT04354701) to examine the impact of recent systemic therapies on the clinical outcomes of COVID-19 in patients with TC.
Methods
The CCC19 registry was queried for adult patients with TC and lab-confirmed SARS-CoV-2 infection. Only patients with data quality scores of 0-4 were included in the analysis. The primary outcome was 30-day all-cause mortality. Secondary outcomes were need for oxygen supplementation, hospitalization, ICU admission, and mechanical ventilation. The outcomes were further stratified by demographics, smoking history, ECOG PS (0, 1, >2), cancer status (remission, responding/stable, progressing) and type of systemic treatment <3 months prior to COVID-19 (chemotherapy with or without immunotherapy, chemotherapy plus radiation, immunotherapy alone or targeted therapy).
Results
From January 2020 to December 2021, 900 patients with thoracic cancer met the inclusion criteria. The median age was 70 years (IQR 62-77), 53% were female, 79% were former or current tobacco users, 56% of patients had ECOG PS of 0 or 1, and 34% of patients had active but stable or responding cancer. Fifty-three percent (N=477) of patients received at least one anti-cancer systemic therapy <3 months prior to COVID-19 diagnosis. Chemotherapy with or without immunotherapy was the most prevalent treatment exposure (51%; N=242). After a median follow-up of 70 days (IQR 28-180), 30-day all-cause mortality was similar in patients who received any systemic cancer treatment versus no cancer treatment (23% and 22% respectively). Patients treated with immunotherapy and targeted therapy had the lowest mortality (15% and 18% respectively), the majority of whom were treated with palliative intent. Similar trends were also noted with secondary outcomes (Table 1).
Conclusions
We report one of the largest studies evaluating the clinical outcomes of COVID-19 in the context of recent systemic anti-cancer treatments for TC. While continued caution is required when utilizing systemic treatments, delays in treatment may not be justified. The study provides reassuring data that patients receiving immunotherapy or targeted therapy even in the context of palliative treatment appear to have a lower risk for all-cause COVID-19 mortality. Further analysis exploring the prognostic factors associated with poor outcomes in patients with chemoradiation is planned.
Table 1
| Characteristics | All patients (N = 900) | Chemotherapy +/- immunotherapy (N = 242) | Immunotherapy alone (N = 94) | Chemotherapy and radiation (N=66) | Targeted therapy (N=114) | No cancer treatment (N = 423) |
|---|---|---|---|---|---|---|
| Age [Median (IQR)] | 70 (62-77) | 66 (59-73) | 70 (62-75) | 69 (62-73) | 64 (56-74) | 72 (65-80) |
| Female | 480 (53%) | 56% | 46% | 52% | 65% | 53% |
| Current or Former smoker | 713 (79%) | 79% | 91% | 82% | 47% | 83% |
| ECOG performance status prior to infection | ||||||
| 0 | 183 (20%) | 19% | 19% | 18% | 25% | 21% |
| 1 | 321 (36%) | 42% | 53% | 38% | 42% | 28% |
| 2 or more | 204 (23%) | 26% | 22% | 26% | 18% | 21% |
| Cancer Status | ||||||
| Remission/No evidence of disease | 258 (29%) | <5% | 5% | 9% | 6% | 52% |
| Active, stable/responding | 302 (34%) | 43% | 69% | 39% | 53% | 17% |
| Active, progressing | 217 (24%) | 38% | 19% | 38% | 32% | 17% |
| Treatment intent | ||||||
| Curative | 196 (22%) | 34% | 28% | 52% | 20% | 11% |
| Palliative | 313 (35%) | 60% | 67% | 42% | 73% | 7% |
| Outcomes | ||||||
| 30-day all-cause mortality | 204 (23%) | 26% | 15% | 33% | 18% | 22% |
| Supplemental oxygen | 503 (56%) | 58% | 48% | 62% | 49% | 56% |
| Hospitalization within 30 days | 571 (63%) | 64% | 51% | 71% | 61% | 64% |
| ICU admission | 173 (19%) | 22% | 18% | 27% | 18% | 17% |
| Received mechanical ventilation | 97 (11%) | 12% | 9% | 17% | 12% | 9% |
| Follow up time, days [Median (IQR)] | 70 (28-180) | 53 (18-135) | 70 (30-180) | 90 (13-180) | 90 (28-180) | 80 (30-180) |
Keywords
COVID-19, Immunotherpay, Thoracic Cancers
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© 2022 Published by Elsevier Inc.
