|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 and COVID-19 did not demonstrate a particularly aggressive disease course, according to results from a single-center study presented at the American Association for Cancer Research (AACR) Virtual Annual Meeting I.
Paris has been substantially affected by the SARS-CoV-2 pandemic, and, in response, cancer care at Gustave Roussy has been adapted to prioritize patient care and reduce risk of viral infection. The purpose of this study was to characterize the experience of COVID-19 among patients with cancer treated at Gustave Roussy.
The study included 137 patients with cancer who were managed at Gustave Roussy from March 14 to April 15, 2020, with a median follow-up of 13 days. COVID-19 was diagnosed by real-time polymerase chain reaction (RT-PCR; 93.4%) or CT scan. The primary endpoint was clinical worsening, defined as the need for oxygen supplementation of ≥6 L/min or death due to any cause.
In the cohort, the median age was 61 years, 58% of patients were female, and 36.8% were former or current smokers. Comorbidities were common, and included hypertension (34.3%), diabetes (19.7%), and cardiovascular disease (10.2%). The majority of patients had solid tumors, with the most common being cancers of the breast, gastrointestinal tract, head and neck, genitourinary tract, and gynecological cancers. Hematologic malignancies were also included in the cohort, including mature B-cell neoplasms/myeloma, acute myeloid leukemia, Hodgkin lymphoma, and myelodysplastic syndromes.
Patients were fully asymptomatic in 23% of cases and 20.5% had known exposure to a person with COVID-19 infection. Of the patients with symptoms, the most common at diagnosis were fever, dry cough, fatigue, and dyspnea.
There were 8 pediatric patients with cancer who were diagnosed with COVID-19, with a median age of 3 years. Symptoms were present in 40% of these patients.
Patients were admitted to the hospital in 75% of cases, with 16.1% still hospitalized at the time of the analysis. Clinical worsening occurred in 24.8% of patients, including 11% of patients who were admitted to the intensive care unit and 14.6% who died. All deaths were COVID-19–related.
Hydroxychloroquine/azithromycin was used to treat 29% of the patients in the cohort. The rates of clinical worsening (35%) and death (15%) were similar to the larger cohort.
In a univariate analysis, Eastern Cooperative Oncology Group performance status of more than 1 (hazard ratio [HR], 4.6; 95% CI, 2.2-10.0; P <.0001) and hematologic malignancy (HR, 2.7; 95% CI, 1.3-5.5; P =.008) were significantly associated with clinical worsening. Gender and age, body mass index, smoking status, and active cancer were not associated with clinical worsening.
Treatment with chemotherapy during the last 3 months (HR, 2.60; 95% CI, 1.32-5.13; P =.006) was also significantly associated with clinical worsening, but targeted therapy or immunotherapy during the last 3 months were not.
Kaplan-Meier curves suggested that chemotherapy during the last 3 months and active/metastatic disease status were associated with shorter overall survival. “Meaning, we may probably continue to treat patients in the adjuvant or neoadjuvant setting with cytoxic chemotherapy,” Fabrice Barlesi, MD, PhD, of Gustav Roussy in France and lead author and presenter of the study, said.
Dr Barlesi concluded that these data show that the outcomes at Gustave Roussy seem to be comparable to the global population. But, their analyses suggest that “we have to pay attention to some factors when deciding to treat our COVID-19 cancer patients,” he said.
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Barlesi F, Foulon S, Bayle A, et al. Outcome of cancer patients infected with COVID-19, including toxicity of cancer treatments. Presented at: American Association for Cancer Research (AACR) Virtual Annual Meeting I; April 27-28, 2020. Plenary session.