TERAVOLT Study Identifies 7 Factors Associated with COVID-19 Mortality in Thoracic Cancer


The TERAVOLT study identified 7 factors associated with increased mortality risk for patients with thoracic malignancies who have contracted COVID-19.

Seven significant determinates of mortality have been identified for patients with thoracic malignancies who have contracted COVID-19, according to results from the TERAVOLT study which were published in the Journal of Thoracic Oncology.1

Poor ECOG-performance status had the strongest association with negative COVID-19 outcomes (OR, 2.47; 95% CI, 1.87-3.26), with other factors including neutrophil count (OR, 2.46; 95% CI, 1.76-3.44), serum procalcitonin (OR, 2.37; 95% CI, 1.64-3.43), development of pneumonia (OR, 1.95; 95% CI, 1.48-2.58), c-reactive protein (OR, 1.90; 95% CI, 1.43-2.51), tumor stage at COVID-19 diagnosis (OR, 1.97; 95% CI, 1.46-2.66) and age (OR, 1.71; 95% CI, 1.29-2.26).

“Despite the ongoing efforts including immunization campaigns and increased capacity, SARS-CoV-2 will still impact the continuity of care of patients with cancer, at least to a certain extent. Against the evolving scenario, we provided a comprehensive and powered prognostication system that can be a useful tool for clinicians.” Alessio Cortellini, MD, a medical oncologist and clinical scientist from the Imperial College London, said in a press release.2

A total of 1591 patients were enrolled into the database between March 2020 and April 2021 and 1491 were included in the analysis.

Laboratory confirmed COVID-19 infection was identified in 1432 patients, and 59 patients were diagnosed based on radiological or clinical findings. Investigators reported that 57.3% of patients were male, 72.2% were White, and 77.8% were former and current smokers. The median age for patients was 67 years, and 57.3% of patients were 65 years or older.

Among the patients included in the study, most had 1 comorbidity (82.3%), such as hypertension (48.0%), chronic obstructive pulmonary disease (24.5%), diabetes (19.3%), and ischemic heart disease (13.1%). Moreover, most patients were taking concomitant non-cancer related medications upon bring diagnosed with COVID-19 (73.4%). Prior to the COVID-19 diagnosis, 13.0% of patients were on corticosteroids.

The most common tumor types were non–small cell lung cancer (79.7%), small cell lung cancer (12.4%), and other thoracic malignancies (7.9%). At the time of COVID-19 diagnosis, 67.8% of patients had stage IV disease, 71.9% had an ECOG-performance status of 0 or 1, 64.5% had received antineoplastic treatment within 3 months of the diagnosis, and 38.8% had chemotherapy alone.

Therapy for patients with COVID-19 included anticoagulation agents (37.2%), antibiotics (48.7%), antivirals (18.9%), antifungals (2.6%), corticosteroids (33.4%), interleukin-6 inhibitors (3.1%), and antimalarials (16.4%). During the mean observation period of 42 days, 361 events were reported that translated to an all-cause fatality rate was 24.2%.

A total of 73 variables were considered in the cluster analysis, with significant associations with outcomes identified in 3 demographic , 5 comorbidity , 3 concomitant medication, 3 oncological feature, 6 full blood count information, 17 general biochemistry, 2 respiratory function, and 7 radiological finding variables.

“Currently, this analysis did not look at the impact of COVD-19 vaccination. The TERAVOLT database was recently updated to capture information about vaccination status, as well as information about the specific variants. A separate analysis will be performed with the new data.” Jennifer G. Whisenant, PhD, a research assistant professor of medicine at Vanderbilt University, concluded.


1. Whisenant J, Baena J, Cortellini A, et al. A definitive prognostication system for patients with thoracic malignancies diagnosed with COVID-19: an update from the TERAVOLT registry. J Thorac Oncol. Published online February 1, 2022. doi:10.1016/j.jtho.2021.12.015

2. TERAVOLT study identifies seven factors that increase mortality risk for patients with COVID-19. News Release. International Association for the Study of Lung Cancer. February 1, 2022. Accessed February 1, 2022. https://bit.ly/3ANKRJh

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