The following article features coverage from the American Association for Cancer Research (AACR) 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Patients with cancer who contracted COVID-19 were more likely to present with aggressive COVID-19 disease and experience poor outcomes, according to data from a retrospective study presented at the American Association for Cancer Research (AACR) Virtual Annual Meeting I 2020.1 The study was simultaneously published in the Annals of Oncology.2

Although patients with cancer are generally considered to be particularly vulnerable to COVID-19, the clinical characteristics of patients with cancer who contract the virus is unknown. The purpose of this study was to identify clinical characteristics of these patients and to determine if there are risk factors among this population that can predict more severe COVID-19 disease.

This retrospective study included data from patients hospitalized with COVID-19 infection from January 13 to February 25, 2020, from 3 designated hospitals in Wuhan, China. COVID-19 infections were confirmed by real time-polymerase chain reaction (RT-PCR). Univariate and multivariate analyses were conducted using the Cox proportional hazards model.

There were 28 patients identified with cancer and who were diagnosed with COVID-19 infection, which accounted for 2.2% of patients with COVID-19 in Wuhan. In contrast, the overall proportion of patients with cancer in China is 0.29% and the rate of COVID-19–positive cases in the country is 1.0%. The median age was 65 years and 61% of participants were male. The most common cancer type was lung cancer at 25%, followed by esophageal cancer in 14%, and breast cancer in 11%. Stage IV cancer was present in 36% of patients.


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COVID-19 infection was suspected to be acquired at the hospital among 29% of patients, with the remaining patients thought to have community-acquired infections.

Among the patients with cancer and COVID-19, 54% developed severe COVID-19 disease. There were 79% of patients who required oxygen and 36% who required mechanical ventilation. There were 15 patients who experienced severe events, with a median time from COVID-19 diagnosis to a severe event of 7 days (range, 5-15 days), which, according to Li Zhang, MD, PhD, of Tongji Hospital in China and the lead author and presenter of the study, “is very short.”

There were 50% of patients discharged from the hospital by April 4, 2020, with median duration of hospitalization of 18.4 days (range, 13-21 days). An additional 21% of patients were still hospitalized at the time of the analysis.  

The mortality rate was 29%, with the most common cause of death being acute respiratory distress syndrome in 63%. Other causes of death included septic shock, suspected pulmonary embolism, and acute myocardial infarction, each occurring in 12.5% of deaths.

In the univariate analysis, consolidation on first CT scan on admission was significantly associated with an increased risk of severe events (hazard ratio [HR], 5.00; 95% CI, 1.57-15.9; P =.006).

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Receipt of anticancer medications within 14 days of COVID-19 diagnosis trended toward an increased risk, but was nonsignificant (HR, 2.38; 95% CI, 0.80-7.04; P =.118). In the multivariate, analysis, this association was significant after being adjusted by age and gender (HR, 4.08; 95% CI, 1.09-15.3; P =.037).

“The adjusted survival curve of severe events showed that cancer patients who had anticancer treatment in the past 14 days or patchy consolidation at admission were significantly associated with severe events,” Dr Zhang said.

In addition, the study followed 124 patients with cancer who were receiving immune checkpoint inhibitor treatment. Among these patients, 1 developed COVID-19 infection and experienced a mild course of the disease.

Dr Zhang concluded that these data suggest that “cancer patients with COVID-19 presented with poor outcomes with higher occurrence of clinical severe event and mortality.”

Read more of Cancer Therapy Advisor‘s coverage of AACR 2020 meeting by visiting the conference page.

References

  1. Zhang L, Zhu F, Xie L, et al. The experience of treating patients with cancer during the COVID-19 pandemic in China. Presented at: American Association for Cancer Research (AACR) Virtual Annual Meeting I 2020; April 27-28, 2020. Plenary session.
  2. Zhang L, Zhu F, Xie L, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China.[published online March 26, 2020]. Ann Oncol. doi: 10.1016/j.annonc.2020.03.296