This month, thousands of oncology professionals from around the world will gather virtually to learn about the latest research in the treatment and care of people with cancer. The ASCO20 Virtual Scientific Program will take place online from Friday, May 29, through Sunday, May 31, and will feature over 250 presentations by experts in the field.

The ASCO20 Virtual Scientific Program today features a special session examining the impact of COVID-19 on people with cancer. COVID-19 is the illness caused by the novel (or new) coronavirus, which is called SARS-CoV-2, and it has had a significant impact on global health. The 2 studies in this special session show how the oncology community is actively working together to learn more about how this disease affects people with cancer. Both studies were started in March, and these analyses are based on data that were collected in just 2 months. This is early research, and much more still needs to be learned.

• Early data show progressing cancer is linked with increased risk of death in people with cancer and COVID-19

• Previous chemotherapy is linked with increased risk of death in people with thoracic cancer and COVID-19

Be sure to talk with your health care team about any questions you have about COVID-19 and whether it could affect your cancer treatment. Read more about COVID-19 and what people with cancer should know about it, in a different Cancer.Net blog post.

Early data show progressing cancer is linked with increased risk of death in people with cancer and COVID-19

An analysis of data from 928 people with cancer and COVID-19 has found that having active, progressing cancer was associated with an increased risk of death. Progressing cancer is cancer that has not been stopped by treatment and is growing or spreading. Being older than 70 years, reduced ability to perform daily tasks, and treatment for COVID-19 with hydroxychloroquine (Plaquenil) and azithromycin, an antibiotic, were also factors strongly linked to an increased risk of death.

The COVID-19 and Cancer Consortium (CCC19) was started on March 15, 2020, to learn more about how COVID-19 is affecting people with cancer and began collecting data within 2 days. The CCC19 receives data from cancer centers and laboratories in the United States and Canada and can receive individual, anonymous patient reports from Argentina, Canada, the European Union, the United States, and the United Kingdom.

Half of the patients in this study were white, while 16% were black, 16% were Hispanic, and 15% were other races and ethnicities. The most common types of cancer in this group were breast cancer (21%), prostate cancer (16%), gastrointestinal cancers (12%), lymphoma (11%), and thoracic cancers (10%), which affect the lungs. Among these patients, 43% had active, or measurable, cancer, 39% were in active cancer treatment, and 45% had cancer in remission.  

In this study, 121 patients had died within 30 days of the COVID-19 diagnosis. The researchers found that the people with cancer that was actively progressing, that is, growing or spreading, were 5.2 times more likely to die within 30 days than people with cancer in remission or with no evidence of disease.

The patients’ ability to perform daily tasks was measured with the ECOG Performance Status score. A Performance Status score of 0 or 1 represents someone who is still able to carry out most of the activities of daily life, such as walking and doing office work. A Performance Status score of 2 or more represents increasingly less physical ability. A Performance Status score of 2 or more was linked with a nearly 4 times greater risk of death within 30 days than in those who had a Performance Status score of 0 or 1.

Also, the researchers found that COVID-19 treatment with a combination of hydroxychloroquine and azithromycin increased the risk of dying by nearly 3 times, compared with those who did not receive these drugs. The researchers did not find a significant increase in the risk of dying if a patient received either of these drugs separately. Those who received the combination of hydroxychloroquine and azithromycin and died were also more likely to have a Performance Status score of 1, have received cancer treatment less than 2 weeks before the COVID-19 diagnosis, have a positive blood type, have a non-Hispanic ethnicity, and have previously received statins, which are drugs used to treat cholesterol levels.

The researchers found other factors that were less strongly associated with an increased risk of dying. Among older patients, the risk of dying further increased by nearly 2 times for every decade of life. Having stable, non-progressing cancer was associated with a 1.79 times greater risk of dying than having no evidence of disease. Men had a 1.63 times greater risk of dying in 30 days than women. Having smoked regularly in the past was linked to a 1.6 times greater risk of dying than having never smoked.

Across all patients in this analysis, 466 of them (50%) were hospitalized due to illness and 132 (14%) needed to be admitted to the intensive care unit (ICU). A total of 116 patients (12%) had to be put on a ventilator, and 405 patients (44%) needed additional oxygen.

What does this mean? When the COVID-19 pandemic began, many hypothesized that people with cancer could be at high risk. This study provides scientific evidence that certain people with cancer with specific risk factors do have a higher risk of death. This knowledge can help guide the medical recommendations for people with cancer during this global pandemic.

“Right now, we’re working to quickly get information about why some patients with cancer become infected with SARS-CoV-2 virus and identify the factors that affect disease severity and death. We're also interested in the effects of treatments that are being used to treat patients with cancer who have COVID-19.”

—   lead study author Jeremy L. Warner, MD, MS, FAMIA, FASCO
Vanderbilt University Medical Center
Nashville, Tennessee

 The abstract number for this study is LBA110. View this study abstract and the authors’ full disclosures on the ASCO website.

Previous chemotherapy is linked with increased risk of death in people with thoracic cancer and COVID-19

People with lung or other thoracic cancers who were treated with chemotherapy within 3 months before a COVID-19 diagnosis have a higher chance of dying, according to an analysis from the TERAVOLT registry. Thoracic cancers affect the lungs, and they include non-small cell lung cancer (NSCLC), small cell lung cancer, neuroendocrine tumor of the lung, mesothelioma, thymoma and thymic carcinoma, and others.

TERAVOLT is a registry of people with thoracic cancers and COVID-19 that includes data from over 400 patients from 26 countries, including China, France, Italy, Spain, and the United States. It was launched in March 2020 by thoracic cancer researchers and clinicians who wanted to learn more about how COVID-19 affects this specific group of patients. These patients are typically older and often have multiple health problems, preexisting lung damage, and other risk factors for COVID-19. The lead author on this analysis is Leora Horn, MD, of Vanderbilt University Medical Center in Nashville, Tennessee.

The researchers found that patients receiving chemotherapy within the last 3 months had a 64% higher risk of dying from COVID-19 than those who did not have chemotherapy. At the time of this analysis, 144 patients had died. Of those, 112 (79.4%) died from COVID-19 and 15 (10.6%) died from cancer. Among those who died were 66 patients (46.8%) receiving chemotherapy, 18 patients (12.9%) receiving a type of targeted therapy called tyrosine kinase inhibitors, and 22 patients (31.0%) receiving immunotherapy alone or in combination with chemotherapy. The increased risk from chemotherapy remained whether the treatment was given alone or in combination with other therapies.

Treatment before a COVID-19 diagnosis with corticosteroids, which are medications to prevent inflammation, was also linked to an increased risk of death. In this study, taking corticosteroids before a COVID-19 diagnosis was associated with a 1.5 times higher risk of death in people with thoracic cancer than in those who did not take them. The researchers also saw a possible connection between earlier treatment with medications to prevent blood clotting, called anticoagulants, and increased risk of death, but there were too few patients who took them in the study to further investigate this observation.

The type of treatment given for COVID-19 did not appear to affect a patient’s risk of dying. The percentages of patients receiving specific treatments for COVID-19 were similar for patients who recovered and for those who died. Among those who recovered, 27% received antibiotics, 24% received anticoagulants, 10% received corticosteroids, and 23% received hydroxychloroquine. Among those who died, 27% received antibiotics, 23% received anticoagulants, 16% received corticosteroids, and 19% received hydroxychloroquine.

What does this mean? This study provides scientific evidence that for people with thoracic cancers and COVID-19, chemotherapy within 3 months of a COVID-19 diagnosis, as well as treatment with corticosteroids before COVID-19, increases the risk of dying. This knowledge can help support the development of more detailed medical guidance about how best to care for people with thoracic cancer during the COVID-19 pandemic.

“A number of factors—preexisting lung damage, smoking status, advanced age, and comorbidities—make patients with thoracic cancers especially vulnerable to COVID-19. 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.”

—   Howard A. Burris III, MD, FACP, FASCO
ASCO President

The abstract number for this study is LBA111. View this study abstract and the authors’ full disclosures on the ASCO website.