Petros Grivas, MD, PhD, on Future Updates to the COVID-19 and Cancer Consortium

July 9, 2020

Data from the registry suggested that in patients with cancer and COVID-19, cancer that is progressing was independently associated with an increased risk of death.

Data from 928 patients included in the COVID-19 and Cancer Consortium (CCC19), presented at the 2020 American Society of Clinical Oncology (ASC) Virtual Scientific Program, suggested that in patients with cancer and coronavirus disease 2019 (COVID-19), cancer that is progressing was independently associated with an increased risk of death.

Additionally, treatment of COVID-19 with both hydroxychloroquine and azithromycin was also strongly associated with an increased risk of death.

Overall, 1018 cases were accrued from March to April 2020. Breast (20%) and prostate (16%) cancers were most common, and 43% of patients were on active anti-cancer treatment. At the time of data analysis, 106 patients (10.4%) had died and 26% met the composite outcome of death, severe illness requiring hospitalization, and/or mechanical ventilation.

In multivariable logistic regression analysis, independent factors associated with increased 30-day mortality were age, male sex, former smoking, ECOG performance status (2 versus 0/1: partially adjusted odds ratio [pAOR] 2.74, 95% CI 1.31-5.7; 3/4 versus 0/1: pAOR 5.34, 95% CI 2.44-11.69), active malignancy (stable/responding, pAOR 1.93, 95% CI 1.06-3.5; progressing, pAOR 3.79, 95% CI 1.78-8.08), and receipt of azithromycin and hydroxychloroquine. However, tumor type, race/ethnicity, obesity, number of comorbidities, recent surgery, and type of active cancer therapy were not found to be significant factors for mortality.

In an interview with CancerNetwork®, Petros Grivas, MD, PhD, board-certified oncologist at the Seattle Cancer Care Alliance (SCCA), director of the University of Washington (UW) School of Medicine’s Genitourinary Cancers Program, and a UW professor of Oncology, discussed future updates to the registry and what he and his colleagues hope to include moving forward.

Transcription:

We tried very hard to update the survey, especially in the first few weeks based on the literature that was emerging at the time to have a more relevant and, you know, acute questions. And going forward, we can always update the data with longer follow-up and also try to capture, you know, any other information. As you know, there was a publication, the… with a clinical trial with remdesivir (GS-5734). And then other clinical trials with other medications as well. So, our intent is to capture as much data as possible, and as I mentioned before, update the report in the near future.

We’ll also look at other variables. For example, location. As you know, some areas were affected more than others and some health systems were overwhelmed, as also there are other differences in terms of the availability of resources, availability of palliative care, that can confound the results. So, we’ll also look at geographical differences in our data as well as, you know, a readiness of the resources, availability, which is very hard to capture as you can imagine in a survey like that. So, it’s not possible to capture every possible answer, but definitely we’re looking forward to informing more of the literature.

Interestingly, and I think this is an important point, based on the current data…, there was no significant association between the 30-day mortality and cancer treatment, suggesting that patients who need treatment for their cancer, they should get treatment for their cancer. That’s an important take home point, of course we have to use extreme caution for those patients and we have to be careful how to help them prevent infections, but I think it’s important to understand you have a balance individualized discussion with a patient, one by one, balance the benefits and risks for each situation based on risk factors, and of course use extreme precautions, but cancer itself can be a risk for those patients and we have to think about how we can optimally continue or start their treatments for that as well.