Thoracic Cancer Mortality After COVID-19 Not Linked To Recent Systemic Therapy

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Recent receipt of systemic anticancer therapy does not predict all-cause mortality within 30 days of COVID-19 infection among patients with thoracic cancer, shows research reported at the IASLC World Conference on Lung Cancer 2022 in Vienna, Austria. 

Presenting author Amit Kulkarni, from the University of Minnesota in Minneapolis, USA, said that the analysis of the CCC19 registry “provides reassuring data for not withholding or delaying systemic cancer treatment in the context of recent COVID-19.” 

The team collated information for 903 patients with thoracic cancer who had laboratory-confirmed SARS-CoV-2 infection and were followed up for a median of 70 days.  

The patients were aged a median of 70 years, 53% were women and the majority were non-Hispanic White (59%), former smokers (64%) and based in the USA (91%). 

ECOG performance status was known and 0, 1 and 2 or higher in 20%, 36% and 23% of patients, respectively, and comorbidity was common, most frequently pulmonary (49%), followed by cardiovascular comorbidity (29%), diabetes (28%) and renal comorbidity (13%). Although 75% of patients were not using steroids, a dose of more than 10 mg prednisone daily equivalent (PDE) was reported for 6% and a lower dose in 11%. 

Among the 780 patients with a known cancer status, 29% were in remission or had no evidence of disease, 34% had active disease that was stable or responding to treatment and 24% had progressive disease. 

In the 3 months before COVID-19 infection, 27% of the full cohort had received chemotherapy with or without immunotherapy, 13% targeted therapy, 10% immunotherapy alone, 7% chemotherapy with radiation and 47% no systemic treatment. 

Overall, the primary outcome of 30-day all-cause mortality in the patients with thoracic cancer was “high at 22%, consistent with published data”, Amit Kulkarni told delegates. 

But 30-day mortality varied by treatment received, from 33% after chemotherapy and radiation and 26% after chemotherapy with or without immunotherapy, to 18% after targeted treatment and 15% after immunotherapy alone. And 22% of patients who did not receive systemic treatment in the 3 months before COVID-19 infection died within 30 days. 

Amit Kulkarni noted that, as well as having the worst 30-day mortality rate, patients who had received a combination of chemotherapy and radiation were the most likely to receive supplemental oxygen in hospital (58%) and require intensive care (27%) or mechanical ventilation (17%).  

Nevertheless, multiple regression analysis, taking into consideration demographics, comorbidity, smoking status, ECOG performance status and cancer factors, did not show a relationship between the likelihood of 30-day mortality or COVID-19 severity and recent receipt of any type of treatment.  

Instead, patients were more likely to die within 30 days of infection or have severe COVID-19 if they had a ECOG performance status of 2 or more (odds ratios [ORs]=7.73 and 5.21, respectively) or if they had cancer that was progressing (ORs=6.72 and 4.30), although the presenter commented that the 95% confidence intervals for these factors were “pretty wide”. 

Thirty-day mortality and severe COVID-19 were also associated with other factors including baseline steroid use of greater than 10 mg PDE (ORs=1.93 and 1.83, respectively) and the presence of pulmonary comorbidities (ORs=1.67 and 1.58). 

By contrast, a COVID-19 diagnosis in the autumn of 2021 was associated with a lower risk for 30-day mortality and severe disease compared with the first 4 months of 2020 (ORs=0.17 and 0.39, respectively), “suggesting a revolution of treatment and probably vaccine”, the presenter said. 

Session discussant Marina Garassino, from the University of Chicago in Illinois, USA, said the CCC19 findings were “very consistent” with those of the TERAVOLT study, which also found ECOG performance status as the strongest prognostic factor for survival. 

Nevertheless, she cautioned that “the heterogeneity of the variants can change the scenario again” and that research must “stay active in this field”. 

Reference  

OA06.06: Kukarni A, Hennessy C, Wilson G, et al. Impact of systemic anti-cancer treatments on outcomes of COVID-19 in patients with with thoracic cancers: CCC19 registry analysis. IASLC World Conference on Lung Cancer 2022; Vienna, Austria: 6–9 August.