The following article features coverage from the European Society for Medical Oncology 2020 virtual meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

An analysis of data from the COVID-19 and Cancer Consortium (CCC19) registry suggested that patients with cancer receiving chemoimmunotherapy within 12 months of COVID-19 diagnosis have an increased 30-day mortality risk compared with patients treated with other types of systemic therapy during this time period. These findings were presented at the European Society of Medical Oncology (ESMO) Virtual Congress 2020.1

The CCC19 registry (ClinicalTrials.gov Identifier: NCT04354701) was created in 2020 for the purpose of prospectively collecting and rapidly disseminating deidentified data about patients with cancer who have been diagnosed with COVID-19 in order “to generate hypothesis-generating and hypothesis-supporting findings that are generalizable to the population at large.”2

With more than 120 cancer centers and other organizations currently participating in CCC19, the consortium allows for web-based submission of patient data using a simple 5-part survey covering patient demographics and medical history, information on the initial course of infection with SARS-CoV-2, cancer-related history, details specific to the respondent, and additional information to allow for longitudinal patient follow-up.2

While results of some small studies have suggested that patients with cancer receiving recent systemic cancer treatment have worse outcomes following infection with SARS-CoV-2, this conclusion was not supported by a previous evaluation of CCC19 data involving 928 patients who had received systemic cancer treatment within 4 weeks of COVID-19 diagnosis compared with no treatment.3


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In this study, the same question was reexamined in an expanded overall cohort of 3654 adult patients included in the CCC19 registry, 44% of whom had received systemic cancer therapy within 12 months of COVID-19 diagnosis and were stratified according to the timing of most recent systemic anticancer therapy prior to diagnosis of COVID-19 for periods covering less than 2 weeks, 2 to 4 weeks, 1 to 3 months, and 3 to 12 months.

Although the percentage of patients with distant disease was lower if they had not received systemic cancer treatment within at least 3 months prior to COVID-19 diagnosis, and those treated within 1 to 3 months of COVID-19 diagnosis were more likely to have active/progressing disease compared with patient cohorts most recently treated at different time points, the proportions of patients receiving different types of therapy were generally similar across time points. Notable exceptions were endocrine therapy and cytotoxic therapy, which were more and less likely, respectively, to have been administered within 2 weeks of COVID-19 diagnosis compared with the other groups.

“Overall, patients with cancer had high rates of complications, including hospitalization, oxygen requirement, intensive care unit care, intubation and mechanical ventilation, and death whether they received anticancer treatment prior to COVID-19 [diagnosis] or had been in remission not requiring treatment,” commented the presenting author, Trisha Wise-Draper, MD, PhD, associate professor of medical oncology at the University of Cincinnati Cancer Center, Cincinnati, Ohio.

While the 30-day mortality rate of patients not receiving systemic therapy during this period was 14%, it was 28% for those undergoing systemic therapy within 1 to 3 months of COVID-19 diagnosis. In comparison, those patients receiving their last systemic cancer treatment less than 2 weeks, 2 to 4 weeks, and 3 to 12 months prior to diagnosis of COVID-19 had mortality rates of 17%, 17%, and 18%, respectively.

Furthermore, for the overall cohort of patients undergoing systemic cancer treatment within 12 months of COVID-19 diagnosis, the 30-day mortality rate according to type of treatment received was highest for those treated with chemoimmunotherapy at 30% and lowest for those receiving endocrine therapy at 11%, with 30-day mortality rates for those receiving chemotherapy, immunotherapy, chemoradiotherapy, and targeted therapy were reported to be 18%, 14%, 18%, and 17% respectively.

“Immunotherapy-alone [patients] had similar rates of death compared with those not on treatment within the past year,” Dr Wise-Draper emphasized.

Using the standard mortality ratio (SMR) to investigate the impact of anticancer type and timing of treatment, with the SMR denominator represented by the overall cohort, the SMR for patients treated with chemoimmunotherapy within 2 weeks of COVID-19 diagnosis was 2.13 (95% CI, 1.02-3.91), although the SMRs for those receiving immunotherapy alone and endocrine therapy alone at this time point were 0.93 (95% CI, 0.44-1.70) and 0.64 (95% CI, 0.44-0.89), respectively.

Although SMRs for patients receiving chemoimmunotherapy were not available for other treatment time points, when considering the cohort of patients receiving systemic anticancer therapy within 1 to 3 months of COVID-19, those receiving targeted therapy during this time period had the highest risk of mortality with a SMR of 2.31 (95% CI, 1.59-3.25).

“Anti-CD20 inhibitors and [vascular endothelial growth factor] inhibitors were the most common drugs administered in the targeted therapy group and had high mortality if given 1 to 3 months prior to infection,” commented Dr Wise-Draper.

“The most striking data,” she continued, was that patients who had been given CD20 antibodies “1 to 3 months prior, even if given for curative intent, had a high mortality rate of 47%, indicating that B-cell depletion may increase risk for severe COVID-19 infection.”

In her concluding remarks, Dr Wise-Draper noted that “these data should be interpreted with caution as they were largely unadjusted descriptive statistics with some missing data.”

Disclosures: CCC19 is sponsored by the Vanderbilt-Ingram Cancer Center with funding provided by the National Cancer Institute. For a full list of disclosures, please refer to the study abstract.

Read more of Cancer Therapy Advisor‘s coverage of the ESMO Virtual Congress 2020 by visiting the conference page.

References

  1. Wise-Draper TM, Desai A, Elkrief A, et al. Systemic cancer treatment-related outcomes in patients with SARS-CoV-2 infection: A CCC19 registry analysis. Presented at: European Society of Medical Oncology (ESMO) Virtual Congress 2020; September 19-21, 2020. Abstract LBA71.
  2. The COVID-19 & Cancer Consortium. https://ccc19.org/. Accessed September 19, 2020.
  3. Kuderer KM, Choueiri TK, Shah DP, et al.  Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395:1907-1918. doi:10.1016/S0140-6736(20)31187-9