Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

• Published in: Annals of oncology Vol. 32; no. 6; pp. 787 - 800
• Main Authors: Khaki, A.R., Wise-Draper, T.M., French, B., Hennessy, C., Hsu, C.-Y., Shyr, Y., Painter, C.A., Peters, S., Rini, B.I., Mishra, S., Rivera, D.R., Acoba, J.D., Bashir, B., Bekaii-Saab, T., Berg, S., Bernicker, E.H., Bilen, M.A., Bindal, P., Bishnoi, R., Bouganim, N., Bowles, D.W., Cabal, A., Caimi, P.F., Crowell, J., Desai, A., Dixon, B., Doroshow, D.B., Durbin, E.B., Farmakiotis, D., Fazio, A., Fecher, L.A., Friese, C.R., Fu, J., Gadgeel, S.M., Glover, M.J., Goyal, S., Grover, P., Gulati, S., Gupta, S., Halabi, S., Halfdanarson, T.R., Halmos, B., Hausrath, D.J., Hawley, J.E., Hsu, E., Jani, C., Jayaraj, A., Johnson, D.B., Kasi, A., Khan, H., Kuderer, N.M., Kwon, D.H., Li, A., Loaiza-Bonilla, A., Low, C.A., Lustberg, M.B., Lyman, G.H., McKay, R.R., McNair, C., Menon, H., Mesa, R.A., Mundt, D., Nagaraj, G., Nakasone, E.S., Nizam, A., Nock, N.L., Patel, J.M., Patel, K.G., Peddi, P., Pennell, N.A., Piper-Vallillo, A.J., Puc, M., Reeves, M.E., Reuben, D.Y., Rosovsky, R.P., Salazar, M., Schmidt, A.L., Schwartz, G.K., Shah, M.R., Shah, S.A., Shah, C., Shaya, J.A., Stockerl-Goldstein, K.E., Streckfuss, M., Subbiah, S., Tachiki, L., Thakkar, A., Tucker, M.D., Verma, A.K., Vinh, D.C., Weiss, M., Wu, J.T., Wulff-Burchfield, E., Xie, Z., Yu, P.P., Zhou, A.Y., Zhu, H., Zubiri, L., Warner, J.L., Lopes, GdL
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2021; The Author(s). Published by Elsevier Ltd on behalf of European Society for Medical Oncology
• Subjects: Aged; anticancer therapy; cancer; COVID-19; COVID-19 Testing; Female; Humans; laboratory measurements; Male; neoplasm; Neoplasms - drug therapy; Neoplasms - epidemiology; Original; outcomes; Pandemics; SARS-CoV-2; SARS-CoV2; anticancer therapy; SARS-CoV2; neoplasm; cancer; outcomes; laboratory measurements
• ISSN: 0923-7534; 1569-8041; 1569-8041
• DOI: 10.1016/j.annonc.2021.02.024

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. NCT04354701 •Among 4966 patients with COVID-19 and a history of or active cancer, 58% were hospitalized and 14% died within 30 days.•Older age, male sex, obesity, comorbidities, non-Hispanic black race, and Hispanic ethnicity were associated with higher COVID-19 severity.•Worse performance status, hematologic malignancy, and recent cytotoxic chemotherapy were associated with more severe COVID-19.•Low or high absolute lymphocyte count, high absolute neutrophil count, low platelets, abnormal creatinine, troponin, lactate dehydrogenase, or C-reactive protein were associated with more severe COVID-19.•Specific anticancer therapies were associated with high 30-day all-cause mortality.