Updated findings from a cohort of patients with cancer infected with COVID-19 included in the COVID-19 and Cancer Consortium (CCC19) were published by Petros Grivas, MD, PhD, and colleagues in Annals of Oncology. Authors identified factors associated with a more severe viral infection among patients with a history of or active cancer.

The authors found that among 4,966 patients with COVID-19 and a history of or active cancer, 58% were hospitalized and 14% died within 30 days. Older age, male sex, obesity, comorbidities, Black race, and Hispanic ethnicity were associated with more severe COVID-19. Furthermore, worse Eastern Cooperative Oncology Group (ECOG) performance status, hematologic malignancy, and recent cytotoxic chemotherapy were associated with more severe COVID-19 infection.

Petros Grivas, MD, PhD

The authors reported in the background that patients with cancer comprise a heterogeneous population. Better understanding of specific risk factors associated with poor COVID-19 outcomes may help guide clinical management in these patients. Leveraging detailed information from almost 5,000 patients with cancer and COVID-19, researchers from an international CCC19 consortium evaluated the hypothesis that specific demographic characteristics, clinical factors, and laboratory measurements are associated with severity of COVID-19 infection. They also explored the impact of specific anticancer therapies on COVID-19 severity and 30-day all-cause mortality.

Patients with active or history of cancer and a laboratory-confirmed SARS-CoV-2 infection between March 17 and November 18, 2020, were included in the analysis. The primary outcome was COVID-19 severity measured on a scale as uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, and died within 30 days. Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19–directed therapies, and laboratory measurements among hospitalized patients.

Median age among the 4,966 included patients was 66 years; 51% were female; and 50% were White. In total, 2,872 (58%) were hospitalized and 695 (14%) died. In total, 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis.

Specific Factors Identified

Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, Black race, Hispanic ethnicity, worse ECOG performance status, recent treatment with cytotoxic chemotherapy, and hematologic malignancy were associated with more severe COVID-19 infection.

Among hospitalized patients, low or high absolute lymphocyte count, high absolute neutrophil count, low platelet count, abnormal creatinine, troponin, lactate dehydrogenase, and C-reactive protein were also associated with more severe COVID-19.

Patients diagnosed early during the COVID-19 pandemic—in particular, from January to April 2020—had worse outcomes than patients diagnosed later in the pandemic.

Specific anticancer therapies (eg, R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

Some chemotherapy regimens were associated with high all-cause mortality. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

These findings can inform novel translational research, clinical trial designs, and clinical decision-making for patients with cancer and COVID-19.

The CCC19 researchers plan further investigation into health-care disparities, outcomes for specific cancer subtypes, and the impact of particular anticancer therapies.

Disclosure: For full disclosures of the study authors, visit annalsofoncology.org.