How Does COVID-19 Impact on the Prognosis of Patients With Cancer?

Early in the COVID-19 pandemic, findings from small subsets of cancer patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared to show an increased risk of mortality compared with the general population. At ESMO Virtual Congress 2020, three presentations described analyses that could help identify potential prognostic factors for mortality in patients with cancer and COVID-19.

Results from Europe’s largest prospective dataset of patients with cancer and COVID-19 revealed an adverse impact of malignancy on prognosis, with a hazard ratio of 1.62 (95% confidence interval [CI], 1.56–1.68; p<0.001) for mortality in patients with cancer versus without cancer (Abstract 1670O). Data from 5,346 patients with a history of cancer and 1,680 patients on active treatment for cancer admitted to hospital with COVID-19 were analysed by the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol, which collects detailed clinical information and outcomes for thousands of patients. In hospitalised patients with cancer and COVID-19, the mortality rate was high at 44.3% in those with a history of cancer and 42.3% in those on active treatment for cancer, compared with 29.5% in the 59,568 patients with no cancer.

Investigating thoracic malignancies only, the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry, which has analysed data of 1,012 patients from 20 countries up to mid-July this year, revealed that 72% of patients were hospitalised, 47% developed pneumonia as a complication, and around one-third (32%) died while infected with COVID-19 (Abstract LBA75). Patients with thoracic malignancies are thought to be particularly susceptible to COVID-19 given their older age, smoking habits, and pre-existing cardiopulmonary comorbidities, in addition to cancer treatments. Of note, the median delay to restarting oncology treatment after recovering from COVID-19 infection was 21 days. In multivariate analysis, age ≥65 years, active smoking, higher stage of cancer, ECOG PS ≥2 and steroids prior to COVID diagnosis were associated with increased risk of death. Chemotherapy and tyrosine kinase inhibitor use were not associated with increased mortality and, interestingly, patients on immunotherapy appeared to be at decreased risk for mortality.

With regard to other prognostic factors which may be useful for patients’ assessment, efforts from the COVID-19 and Cancer Consortium (CCC19) confirm that older age, male sex, smoking and two or more comorbidities seem to be associated with a higher risk of mortality for COVID-19.

According to the updated results presented, these risk factors were associated with worse 30-day mortality in a large cohort of patients with active or prior cancer and COVID-19 (Abstract LBA72). Other factors identified in the CCC19 database were Eastern Cooperative Oncology Group performance status (ECOG PS) ≥1, progressive cancer, haematological cancer, more than one cancer and severe baseline COVID-19 at presentation. In the current analysis of 3,899 patients – mostly from the US – 30-day mortality was 15% overall and 25% in hospitalised patients. Among hospitalised patients, the laboratory parameters of high or low absolute lymphocyte count, high absolute neutrophil count, low platelets, and abnormal levels of creatinine, D-dimer, high-sensitivity troponin or C-reactive protein were associated with a worse prognosis. 

Further updates from the registries, which are still ongoing, will help to better assess cancer patients and refine strategies to manage treatments in the COVID-19 era.

Abstract and session details

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