Cancer Progression Linked to Increased Risk of Death Within 30 Days of COVID-19 Diagnosis

Disease progression and treatment with hydroxychloroquine and azithromycin were associated with increased all-cause 30-day mortality in patients with cancer compared to patients either in remission or with no evidence of disease, according to data presented during a 2020 ASCO Virtual Scientific Program press briefing.¹

“The effects of COVID-19 on patients with cancer remain poorly understood,” lead study author Jeremy L. Warner, MD, MS, an associate professor of medicine and biomedical informatics at Vanderbilt University Medical Center, said during a pre-recorded presentation. “There are some published reports, but they tend to be on the smaller side, or focused on a specific geographic region.”

As a result, researchers wanted to collect a larger and more representative sample to learn more about the impact COVID-19 has on cancer, anticipating that patients with cancer could be at a greater risk due to several factors including:

·      Overall increased age;

·      More comorbidities;

·      More healthcare contacts;

·      Decreased immunity, and

·      Decreased performance status.

On March 15, The COVID-19 & Cancer Consortium (CCC19) was founded and started receiving reports on March 17. The consortium consists of a survey that is designed for real-time reporting as well as after a course of COVID-19 is complete. Site-level participation includes institutions from the United States and Canada, as well as anonymous reports from individuals in several other countries and regions.

This first analysis includes data from 928 cases. Median age of the patients was 66 years. Of note, according to Warner, 30% of the patients were over the age of 75.

Half of the patients were white, 16% were black or African American and 16% were Hispanic. Less than half (39%) of the patients were on active treatment and 43% had active cancer. 

Breast (21%), prostate (16%) and gastrointestinal (12%) cancer were the three most common types of cancer in the patient population. 

More than half (52%) of the patients were never smokers, 37% were former smokers and only 5% were current smokers. 

After a median follow-up of 21 days, 13% of the patients have died. Seventy patients aged older than 75 years have died, and 25 deaths have occurred in patients with progressing disease. 

Half of the patients were hospitalized, of whom 23% have died. The researchers also assessed outcomes in the 132 patients who were admitted to the ICU. Of those 132 patients, 38% died, and of those deaths, 54% occurred in patients older than 75.

Approximately 20% of patients received a combination of hydroxychloroquine and azithromycin, and another 10% received hydroxychloroquine alone. Of note, according to Warner, only two patients received the drugs as part of clinical trials. The rest received the drug off label. 

“Since these drugs are generally available, that's at the discretion of the treating provider but it's still notable,” Warner said. 

Patients who were hospitalized, according to Warner, were more likely to receive hydroxychloroquine and azithromycin, although he did note that hospitalization as a proxy for the criticality of an illness should be done with caution since policies vary from country to country.

Treatment with hydroxychloroquine and azithromycin was associated with a 2.89-fold greater risk of death in patients with cancer and COVID-19 compared with those who were in remission or had no evidence of active disease. However, as Warner noted, hydroxychloroquine alone was not a significant risk factor for death after adjusting for other factors. 

“Prospective trials are needed to clarify whether there is a benefit or a risk to these drugs, alone or in combination,” Warner said during the press briefing. “I think what we found is somewhat consistent with The Lancet article that was published last week based also on a retrospective analysis. Our dataset is somewhat prospective, some of the reports are retrospective. Even with the prospective reports, they are not being made by the treating provider.” 

References:

1. Warner JL. Clinical impact of COVID-19 on patients with cancer: Data from the COVID-19 and Cancer Consortium (CCC19). Presented at: 2020 ASCO Virtual Scientific Program; May 26, 2020. LBA110.