Researchers have linked prior use of chemotherapy with an increased risk of death in patients with lung and other thoracic cancers and with diagnosis of the coronavirus disease 2019 (COVID-19), according to a program at the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting, May 29-31.1

The recent analysis studied 400 patients with thoracic cancers who received chemotherapy, alone or in combination with other treatments, within 3 months of being diagnosed with COVID-19. Researchers found only these patients had a 64% increased risk of dying from the virus compared with patients who did not receive chemotherapy.1

Of the patients studied, 33.3% have died.2 Of those 144 deaths, 79.4% were due to COVID-19 and 10.6% were due to cancer.1  

The analysis relied on the most recent available data from the Thoracic cancERs international coVid 19 cOLlaboraTion (TERAVOLT) registry1,2 and included patients from at least 26 countries.2 

Patients with thoracic malignancies, which include lung cancer, mesothelioma, thymic neoplasms, and carcinoid tumors, are considered high risk given their older age, multiple comorbidities, and pre-existing lung damage, among other factors.1 

The analysis showed that a majority of the 400 patients (76%) studied were hospitalized with 9% admitted to the ICU, and 2.5% required mechanical ventilation.2

In addition to chemotherapy, treatment with anticoagulants and corticosteroids prior to COVID-19 were associated with an increased risk of death.1,2 In this study, treatment with corticosteroids prior to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was associated with 1.5 times greater risk of death in patients with thoracic cancer, compared with patients not on corticosteroids, after controlling for a number of other factors.1  

In a prepared statement, ASCO President Howard A. Burris III, MD, FACP, FASCO, said there are a lot of questions surrounding COVID-19, and not many answers. He said this study provides insight into outcome for patients with cancer who are diagnosed with the virus.1

“A number of factors—pre-existing lung damage, smoking status, advanced age, and comorbidities—make patients with thoracic cancers especially vulnerable to COVID-19,” Burris said.1  

Lead author Leora Horn, MD, Ingram Associate Professor of Cancer Research and the director of the Thoracic Oncology Program at Vanderbilt University Medical Center, noted the speed in which the analysis was started.1

In presenting the analysis findings, Horn said the study was truly a global effort and was backed with endorsements from various scientific organizations that helped in getting patients enrolled.2

“In less than a week we had a study enrolling patients,” Horn added, in a prepared statement. “We have seen clinical trials being funded, approved and begin enrolling patients within weeks, when it can often take months or years to get approval for a trial.”1  

Additional data are needed to understand how COVID-19 affects clotting in patients with thoracic cancer. According to researchers, data collection is ongoing and future analyses are planned to examine patient and provider perceptions of the impact of COVID-19 on cancer care.1,2 

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REFERENCES
  1. Chemo Within 3 Months of COVID-19 Diagnosis Associated With an Increased Risk of Death in Patients With Thoracic Cancer [news release]. Alexandria, VA; May 28, 2020: ASCO website. https://www.asco.org/about-asco/press-center/news-releases/chemo-within-3-months-covid-19-diagnosis-associated-increased Accessed June 1, 2020.
  2. Horn L, Gray Whisenant J, Huang LC, et al. TERAVOLT: Thoracic cancERs international coVid 19 cOLlaboraTion: Impact of cancer therapy and COVID therapy on survival. Presented at: 2020 ASCO Annual Meeting; May 29-31, 2020