Patients with cancer are at an increased risk of death due to COVID-19 compared with the general population. And hematologic cancers carry an even greater risk than solid tumors, according to a comprehensive meta-analysis from the Reboot: COVID-Cancer Project presented at the 2021 AACR Virtual Meeting: COVID-19 and Cancer.1 The meta-analysis also found that patients with cancer treated with chemotherapy had no increase in the risk of death due to COVID-19.
“The Reboot: COVID-Cancer Project is a live, publicly available resource that represents the largest collation of cancer-specific survival data to date. Significant heterogeneity in the risk of death from COVID-19 was observed based on age, sex, inpatient proportion, and cancer subtype. The meta-analysis revealed no significant differences in the risk of death for patients on chemotherapy compared with other or no anticancer therapy,” said lead author Catherine Del Vecchio Fitz, MS, PhD, Cofounder and former Chief Scientific Officer at Reboot Rx, Boston.
Catherine Del Vecchio Fitz, MS, PhD
“We did a meta-analysis to better understand the difference between hematologic and solid malignancies in terms of the risk of death. We included eight studies with approximately 4,900 patients that had both solid and hematologic malignancies cohorts reported internally. Comparing them, we found a significantly increased risk of death with hematologic malignancies compared with solid malignancies,” she said.
The meta-analysis adds to the evidence from a number of smaller studies showing that patients with hematologic malignancies have a dramatically greater risk of COVID-19–related death than those with solid tumors, although all patients with cancer are at greater risk. Also, the meta-analysis results support smaller studies showing no increased risk of COVID-19–related death with chemotherapy.
Reboot Rx is the tech nonprofit startup dedicated to fast-tracking the development of affordable cancer treatments by leveraging repurposed generic drugs, artificial intelligence technology, and innovative funding models. The Reboot COVID-Cancer Project is one part of the company’s initiatives.
The Reboot: COVID-Cancer Project includes two data sets: one on all-cause mortality, which currently has 270 published studies and 162 registered clinical trials with a total of 29,846 patients with cancer and COVID-19. Dr. Del Vecchio Fitz did not discuss the results from the second data set on cancer-specific outcomes. More information about both data sets can be found at https://rebootrx.org/covid-cancer.
A total of 83 studies met the criteria for eligibility for the all-cause mortality meta-analysis. These studies included a total of 24,144 patients with cancer and a COVID-19 diagnosis. The overall pooled risk of death for patients with cancer and COVID-19 was 25%, which is much higher than the 1% to 2% reported in the general population.
In eight studies with a total of 4,900 patients with cancer and COVID-19, the risk of COVID-19–related death was 47% greater in those with hematologic malignancies vs solid tumors (P < .0001). In 10 studies totaling 7,737 patients with cancer, chemotherapy was not associated with an increased risk of death due to COVID-19.
Factors Associated With COVID-19 Death
Among patients with hematologic malignancies, the factors most strongly associated with COVID-19–related death included bone marrow failure syndromes, followed by acute myeloid leukemia, plasma cell dyscrasias, lymphomas, mature B-cell neoplasms, and acute lymphoblastic leukemia. Among patients with solid malignancies, the factors most strongly associated with COVID-19–related death included lung cancer followed by prostate cancer, central nervous system/brain tumors, colorectal cancer, bone tumors, soft-tissue and pleura sarcomas, gynecologic, skin, and breast cancers.
Age, sex, and percentage of patients requiring hospitalization were other factors associated with a higher risk of death. Studies that featured patients with a median age older than 65 had a 31% risk of death compared with 17% in studies with a median age younger than 65. Studies with a population more than 55% male had a 31% risk of death, compared with 19% in studies with a less than 55% male population. Lastly, studies where more than 80% of patients were hospitalized had a 31% risk of death, whereas a hospitalization rate of a 50% to 80% was associated with a 24% risk of death, and a hospitalization rate of less than 50% was associated with a 16% risk of death.
“Studies that had a higher median age, a greater percentage of male patients, and a higher percentage of hospitalized patients had a higher risk of death compared to studies that had a lower median age, fewer male patients, or a lower percentage of inpatients,” Dr. Del Vecchio Fitz noted.
“We also extracted several variables from these studies where available—for example, the study type, the median or mean patient age, the percentage of male patients, the percentage of hospitalized patients, the tissue or cancer subtype if available, and the study location,” she said.
“Although we were able to conduct some very robust analyses with the available data, many of the clinical data were not provided in a way to allow analysis of subgroups, even when such information was described in a study,” said Dr. Del Vecchio Fitz.
DISCLOSURE: Dr. Del Vecchio Fitz reported no conflicts of interest.
1. Del Vecchio Fitz C: Comprehensive meta-analysis of COVID-19 mortality rates for 22 cancer subtypes from the Reboot COVID-Cancer Project, an interactive resource with aggregated data from 21,839 cancer patients. 2021 AACR Virtual Meeting: COVID-19 and Cancer. Presented February 5, 2021.
Joseph Alvarnas, MD
Joseph Alvarnas, MD, a hematologist/oncologist and Vice President of Government Affairs at City of Hope, Duarte, California, commented on the Reboot Rx meta-analysis.
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