Cancer Progression Linked to Increased Risk of Death in Patients with COVID-19

Treatment of COVID-19 with both hydroxychloroquine and azithromycin also was strongly associated with increased risk of death.

An analysis of data from 928 patients with the coronavirus disease 2019 (COVID-19) has found an independent association with progressing cancer and an increased risk of death. Additionally, treatment of COVID-19 with both hydroxychloroquine and azithromycin was strongly associated with increased risk of death.

Funded in part by the National Institutes of Health and the American Cancer Society, the study focused on 30-day all-cause mortality. The analysis relied on data from the COVID-19 and Cancer Consortium (CCC19) registry, which included 525 patients with cancer who were diagnosed with COVID-19. Results of the analysis are being presented during the virtual scientific program of the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting, May 29-31.

According to researchers, 13% of patients in the study died within 30 days of diagnosis with COVID-19. After partial adjustment for several baseline factors, patients with progressing cancer were found to be 5.2 times more likely to die within 30 days compared with patients in remission or with no evidence of disease.

Use of a combination of hydroxychloroquine and azithromycin to treat COVID-19 was associated with a 2.89-fold greater risk of 30-day mortality than use of neither drug. However, there was no significant increase in risk associated with the use of either drug alone. Patients who received hydroxychloroquine and azithromycin and later died were more likely to have had slightly diminished daily physical function, received cancer therapy less than 2 weeks before COVID-19 diagnosis, have Rh-positive blood type, be of non-Hispanic ethnicity, and use statins at baseline.

“While these findings are provocative, we believe that there is significant confounding by indication and that carefully planned prospective studies are needed to truly demonstrate the risk or benefit of these drugs,” said lead author Jeremy L. Warner, MD, Associate Professor of Medicine and Biomedical Informatics at Vanderbilt University Medical Center in Nashville, in a prepared statement.

Additionally, diminished ability to perform daily living activities—measured by an Eastern Cooperative Oncology Group (ECOG) Performance Status score of 2 or greater—was associated with a 3.89 times greater risk of 30-day mortality compared with greater physical ability (ECOG score of 0/1). Risk of death at 30 days increased nearly 2-fold (1.83) with each decade of life, and stable, nonprogressing cancer was associated with a 1.79 times greater risk of death than no evidence of disease. Men had a 1.63 times greater risk of 30-day mortality than women and former smokers had a 1.6 times greater risk of mortality than nonsmokers.

The researchers also reported half of the 928 patients included in this analysis were hospitalized following onset of COVID-19. Overall, 14% of all patients studied were admitted to the intensive care unit, mechanical ventilation was required for 12% of these patients, and additional oxygen was required by 44% of patients.

According to Warner, the data used in the study are early and evolving, and additional time is needed to confirm and expand upon the findings of this analysis.

“Right now, we’re working to quickly get information about why some patients with cancer become infected with the SARS-CoV-2 virus and identify the factors that affect disease severity and death. We're also interested in the effects of treatments that are being used to treat patients with cancer who have COVID-19,” Warner said.

The CCC19 registry is open to site-level participation in the United States and Canada and is open to inclusion of anonymized individuals in Argentina, Canada, the European Union, the United States, and the United Kingdom.

Data collected up to April 16, 2020 show half of patients in the registry were men, half were white, 16% were black, 16% were Hispanic, and 15% were other races and ethnicities. Breast cancer (21%) was the most common cancer, followed by prostate (16%), gastrointestinal (12%), lymphoma (11%), and thoracic (10%). In all, 43% of patients had active (measurable) cancer, 39% were on cancer treatment, and 45% were in remission.

Howard A. Burris III, MD, FACP, FASCO, ASCO president, said CCC19 is an example of the cancer care community coming together and collecting needed data on a large scale.

“The cancer care community urgently needs data on the effects of COVID-19, specifically in patients with cancer. How we improve the care we provide these patients and reduce the number of deaths and severe consequences associated with this disease are among the top questions,” Burris said in a prepared statement.

Researchers are planning to conduct further analyses on this dataset.

REFERENCE

Early Data Show Cancer Progression Associated With Increased Risk of Death in Patients With COVID-19 [news release]. Alexandria, VA; May 28, 2020: ASCO website. https://www.asco.org/about-asco/press-center/news-releases/early-data-show-cancer-progression-associated-increased-risk Accessed May 29, 2020.