Data from the global TERAVOLT Consortium, which is investigating the impact of COVID-19 infection on patients with thoracic cancers, have found that these patients are at high risk for hospitalization and death. Prior use of chemotherapy was associated with an increased risk of mortality, as was the use of steroids or anticoagulants. Prior administration of immunotherapy and chemoimmunotherapy were not associated with an increased risk of death, and prior treatment with tyrosine kinase inhibitors appeared to be associated with a decreased risk of hospitalization. The study was presented by Leora Horn, MD, at the ASCO20 Virtual Scientific Program and featured in a press briefing prior to the meeting (Abstract LBA111).

Leora Horn, MD

Early reports on patients with cancer infected with COVID-19 suggested a high mortality rate compared to the general patient population. Patients with thoracic malignancies are considered high-risk given their age and preexisting comorbidities, as well as due to the therapies administered to treat their illness. The global TERAVOLT consortium was launched to collect data on patients with thoracic malignancies diagnosed with COVID-19 infection to understand the impact of the virus on these patients.

“In less than a week we had a study enrolling patients,” said Dr. Horn, the Ingram Associate Professor of Cancer Research and the Director of the Thoracic Oncology Program at Vanderbilt University Medical Center. “We have seen clinical trials being funded, approved and begin enrolling patients within weeks, when it can often take months or years to get approval for a trial.”  

Study Methodology

The goals of the consortium are to provide data to guide oncology professionals in managing patients with thoracic malignancies while understanding the risk factors for morbidity and mortality from the coronavirus. The researchers’ updated analysis included data on 400 patients. Median age of the patient population was 68 years, the majority of the patients were male, and a small percentage of patients were never-smokers. Most of the patients had non–small cell lung cancer, and 60% to 75% had stage IV disease.

Study Results

Seventy-three percent of patients required hospitalization. The researchers’ analyses found that of the 141 (35.5%) patients that died, 112 (79.4%) died from COVID-19, and 15 (10.6%) died from their cancer. Three hundred and thirty-four patients (78.3%) were hospitalized; 33 (8.3%) were admitted to the intensive care unit; and 20 (5%) needed mechanical ventilation. The median length of hospitalization among these patients was 10 days.

In addition, an analysis of patients’ cancer therapy prior to their COVID-19 diagnosis found that 45% of the patients who died had received chemotherapy, 20% of the patients who died received immunotherapy, and ≤ 10% of patients who died received targeted therapy or radiotherapy. At the time of their COVID-19 diagnosis, the majority of patients were either untreated or on first-line therapy.

Risk factors associated with mortality were age over 65; the presence of comorbidities; Eastern Cooperative Oncology Group (ECOG) performance status greater than 1; treatment with steroids at ≥10 mg per day; and treatment with anticoagulants and chemotherapy.

The findings from this study could lead to a better understanding of the risk factors associated with poor outcomes in patients with thoracic cancer who become infected with COVID-19.

Perspective

Howard A. Burris III, MD, FACP, FASCO

“A number of factors—preexisting lung damage, smoking status, advanced age, and comorbidities—make patients with thoracic cancers especially vulnerable to COVID-19,” said ASCO President Howard A. Burris III, MD, FACP, FASCO, in a statement. “There are a lot of questions right now, and not a lot of answers. These findings give us some insights into outcomes for patients with cancer who develop COVID-19.”

Disclosures: For full disclosures of the study authors, visit coi.asco.org.