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COVID-19 Susceptibility, Severity May Vary By Tumour Type

UK data suggest the risk of acquiring COVID-19 and the severity of infection differ by the type of cancer
28 Aug 2020
COVID-19 and Cancer
Haematological Malignancies;  Prostate Cancer

Author: By Shreeya Nanda, Senior medwireNews Reporter 

 

medwireNews: An analysis of the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort has revealed differing susceptibility to and severity of SARS-CoV-2 infection in patients with different tumour types. 

The researchers have “generated individualised risk tables for patients with cancer, considering age, sex, and tumour subtype”, which they believe “could be useful to assist physicians in informed risk–benefit discussions to explain COVID-19 risk and enable an evidence-based approach to national social isolation policies.” 

Among 1044 UKCCMP participants enrolled between 18 March and 8 May 2020, all of whom had cancer and a laboratory-confirmed diagnosis of SARS-CoV-2 infection, the mortality rate was 30.6%, with COVID-19 recorded as the cause of death in the majority (92.5%) of cases. 

As reported in The Lancet Oncology, the all-cause case fatality rate (CFR) correlated significantly with age, rising significantly from 0.10 in participants aged 40–49 years to 0.48 in those aged at least 80 years and also with sex, such that the risk was significantly higher for men than women (35.6 vs 23.6%; odds ratio [OR]=1.92). 

Analysis by tumour subtype showed that the CFR was significantly increased for patients with leukaemia relative to the reference group of those with digestive tract tumours (excluding colorectal cancer), with an OR of 2.25 after adjustment for age and sex. 

The authors report that prostate cancer was significantly associated with an increased CFR versus the reference tumour type in univariable analysis, while breast and female genital cancers were associated with a decreased CFR, but these associations did not remain significant in multivariable analysis, “highlighting the effect of patient age and sex”. 

Additionally, COVID-19 patients with haematological malignancies (n=227) were significantly more likely than their counterparts with nonhaematological cancers to have a severe or critical COVID-19 disease course, at an adjusted OR of 1.57, and to require high-flow oxygen, noninvasive ventilation or admission to an intensive care unit, at adjusted ORs of 1.82, 2.10 and 2.73, respectively. 

The risk of death during COVID-19-related hospital admission was especially high for haematological cancer patients who had received chemotherapy within 4 weeks of the COVID-19 diagnosis (adjusted OR=2.09), say Gary Middleton, from the University of Birmingham in the UK, and collaborators. 

“The immunological disruption observed in patients with leukaemia and the use of intensely myelosuppressive treatment regimens might result in a combination of risks, in terms of the likelihood of initial SARS-CoV-2 infection, its ability to gain a foothold in the host, and in terms of the downstream disease course and likelihood of severe consequences, such as cytokine storm and multi-organ failure”, they speculate. 

The study authors admit that “there are challenges in interpretation of our findings, as this study relied on ICD-10 cancer subtype codes and leukaemia encompasses a heterogeneous group of conditions”, but note that the results are similar to those reported “in a preprint article from the UK and several Chinese cohorts.” 

And the team concludes: “Future work by the UKCCMP, in collaboration with international consortia, will define risk in much greater granularity, including different subtypes of a given tumour.” 

Reference  

Lee LYW, Cazier J-B, Starkey T, et al. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study. Lancet Oncol; Advance online publication 24 August 2020. doi: 10.1016/ S1470-2045(20)30442-3

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

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