TERAVOLT Consortium Assesses Impact Of COVID-19 Infection On Patients With Thoracic Cancers

Author: By Laura Cowen, medwireNews Reporter 

medwireNews: The Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) has identified age over 65 years, prior steroid use, chemotherapy and an ECOG performance status of 1 as risk factors for death among patients with thoracic cancer and COVID-19 infection. 

Speaking at the virtual 2020 ASCO Annual Meeting, Leora Horn, from Vanderbilt University Medical Center in Nashville, Tennessee, USA, explained that the TERAVOLT consortium was launched to “[d]etermine the demographic factors, comorbidities, cancer characteristics and therapies that place patients with thoracic malignancies who develop COVID-19 most at risk for hospitalization and death.” 

The consortium also hopes to develop greater understanding of the clinical course of infection in these patients and provide practitioners with real-time data on therapeutic strategies. 

Leora Horn presented data for 428 thoracic cancer patients from 26 countries worldwide who were diagnosed with COVID-19 on the basis of laboratory, clinical or radiographic findings. 

At a median 33 days from COVID-19 diagnosis, 169 (39.5%) patients had recovered, 141 (32.9%) had died and 118 (27.6%) had ongoing infection. 

Among the patients who died, 79.4% died due to COVID-19, 10.6% due to cancer, 8.5% due to both causes and 1.4% had an unknown cause of death. 

The majority (78.3%) of patients were admitted to hospital, 8.3% were admitted to the intensive care unit and 5.0% required mechanical ventilation. The median length of hospitalisation was 10 days. 

Across the groups of patients who recovered, died or had ongoing infection, the median age ranged from 67–70 years and median body mass index was 24.0–25.0 kg/m2. The majority (63–70%) of patients were men and the most common cancer was non-small-cell lung cancer (75–82%) with most patients (61–77%) typically having stage IV disease. 

Chemotherapy was the most common cancer treatment that the patients were receiving followed by immunotherapy, targeted therapy and radiation. Around half (48–53%) of patients were receiving first-line therapy, while 18–25% had not yet received any cancer treatment. 

Hypertension (39–53%), chronic obstructive pulmonary disease (18–31%), vascular disease (19–22%), diabetes (15–20%) and renal insufficiency (3–10%) were the most common comorbidities, with each more common among the patients who died than among those who survived. 

Leora Horn also pointed out that, of the patients who recovered, 18.3% had no comorbidities, compared with just 9.2% of the patients who died. 

The most common presenting symptoms were fever (53–68%), cough (37–53%) and dyspnoea (40–78%), while the most common complications were pneumonitis or pneumonia, and acute respiratory distress syndrome, with rates of 71.0% and 49.6%, respectively, among the patients who died and 59.0% and 4.1%, respectively, among those who recovered. 

COVID-19 was typically treated with anticoagulants, antibiotics, antivirals, steroids and hydroxychloroquine, all of which were administered to a similar proportion of patients who recovered or died. 

This shows that “no particular therapy was associated with an increased chance of recovery from COVID-19”, Leora Horn remarked. 

In multivariate analysis, ECOG performance status of 1 (vs 0), chemotherapy with or without immune checkpoint inhibition, age over 65 years and steroid use prior to COVID-19 diagnosis were all associated with a significantly increased risk for death, at hazard ratios of 2.14, 1.71, 1.70 and 1.49, respectively. 

There was no increased mortality risk for patients on immunotherapy or tyrosine kinase inhibitors. 

Leora Horn concluded that “[d]ata collection is ongoing with additional analyses planned to look at patients and provider perception of COVID-19 impact on cancer care.” 

Reference  

Horn L, Whisenant JG, Torri V, et al. Thoracic Cancer International COVID-19 Collaboration (TERAVOLT): Impact of type of cancer therapy and COVID therapy on survival. J Clin Oncol; 38: 18_suppl LBA111. DOI: 10.1200/JCO.2020.38.18_suppl.LBA111.