Cancer History but Not Treatment Worsens COVID-19 Mortality

While COVID-19 patients with a history of cancer face an increased mortality risk versus other patients, active anti-cancer therapy does not appear to worsen outcomes, suggest three studies by UK researchers that underline the importance of ongoing analysis of the pandemic’s impact on cancer.

The research was presented on September 19 at the European Society for Medical Oncology (ESMO) virtual congress 2020, which was held digitally this year due to the COVID-19 pandemic.

Dr Christopher Sng and Dr Heather Shaw, from University College London Hospital, and colleagues studied more than 300 COVID-19 patients with and without cancer, finding the presence of the disease increased the risk of mortality by 57%.

In a second analysis of their patients, they found that none of the individual anti-cancer therapies they studied was associated with a significant increase in mortality risk although all systemic anti-cancer therapies together were linked with increased mortality.

Discuss Concerns With Doctors

Dr Sng and Dr Shaw told Medscape News UK that their results “suggest all patients who are receiving active systemic anti-cancer therapy need to be protected from undue exposure to the virus”.

“This includes attendance for scans, treatment or other routine follow-up,” they said. “Those under surveillance or with previous cancer should discuss their concerns with their physician, and consider potential exposure with caution until further data is available to support a more definitive approach.”

They added that “in the instance of infection resurgence, such as the one we are experiencing now, each patient really needs an individualised plan in collaborative discussion with their oncologist/physician to decide on further treatment and follow-up”.

In a third study presented at ESMO 2020, Dr Anna Olsson-Brown, Clatterbridge Cancer Center – NHS Foundation Trust, Wirral, and colleagues described the UK Coronavirus Cancer Monitoring Project (UKCCMP).

Starting in March 2020, they have quickly expanded to more than 70 centres reporting on over 1200 COVID-19-positive patients with cancer, already providing results that one expert described as “really informative” for the management of cancer patients during the pandemic.

First Poster

For the first poster, Dr Shaw and colleagues studied patients who presented at their hospital between 1 March and 31 May 2020 with COVID-19 infection confirmed on reverse transcription polymerase chain reaction (RT-PCR) testing.

From a total of 680 patients who presented during the study period, they identified 94 (13.8%) who had a history of solid cancer, and these were compared with 226 randomly selected age- and sex-matched patients from the cohort without a cancer history.

The median age of the patients was around 72 years, and approximately one third were female. The most common comorbidities in both patient groups were hypertension, diabetes, cardiovascular disease, and chronic lung disease.

Over a median follow-up period of 18 days, 41 (43.6%) patients with a history of cancer died versus 77 (34.1%) among those without.

The difference became significant among those aged at least 70 years, at 64% versus 44%, or an odds ratio of 2.28 (p=0.02).

Across both cohorts, increasing age was significantly associated with worse survival (p<0.0001), and univariate analysis indicated that South Asian ethnicity and comorbidities were significantly linked to mortality.

Multivariate analysis indicated that the strongest predictor of mortality following COVID-19 infection was South Asian ethnicity, at a hazard ratio (HR) of 2.92 (p<0.001).

This was followed by cerebrovascular disease, at an HR of 1.93 (p<0.01), cancer, at an HR of 1.57 (p=0.03), and age, at an HR of 1.49 for each 10-year increment (p<0.001).

The team say that the results “support the need to continue ‘shielding’ patients with cancer from exposure to the infection”.

“In view of potential resurgences of SARS-CoV-2 infection, treatment plans should account for individual risk factors including age, ethnicity and co-morbidity,” they add.

Second Poster

In a second poster, the researchers looked at the impact of systemic anti-cancer therapy on mortality in the same group of 94 COVID-19 patients with a history of cancer.

Among these cancer patients, South Asian ethnicity was again significantly associated with mortality on multivariate analysis, at an HR of 6.44 (p<0.01), followed by cerebrovascular disease (HR=3.52, p<0.01), hypertension (HR=2.73, p=0.01), and age (HR=1.40 per 10-year increase, p=0.04).

While systemic anti-cancer therapy in general was associated with a significant increase in mortality among cancer patients with COVID-19 infection, at an HR of 2.46 (p=0.03), none of the individual therapies in their analysis significantly increased mortality risk when assessed separately.

This included chemotherapy, endocrine therapy, targeted anti-cancer therapy, and immunotherapy.

Third Poster

In the third poster, Dr Olsson-Brown and colleagues explained that the UKCCMP was a response to the need for a rapid response to the COVID-19 pandemic to provide real-world data in cancer patients.

Starting in March 2020, they developed a national cancer reporting network over four iterative phases, beginning with a project protocol that set out key data requirements and timelines.

This was supported by technical infrastructure to allow clinician-led anonymised data entry into a REDCap [Research Electronic Data Capture] database, and the rapid dissemination of results.

They then identified existing groups to establish an initial network, a process that was boosted through endorsement by professional bodies. After inviting more centres to join the network, they developed a website and social media strategy to further extend the project.

Within the first 4 weeks, more than 50 centres from across the UK joined the project, which grew to more than 70 centres within 6 weeks, reporting on over 1200 COVID-positive cancer patients.

The team said that their rapid response to the COVID-19 pandemic proves that “similar reporting networks can be set up quickly and robustly to react to the evidence-based needs of the oncology community in the drive for…change”.

‘Fantastically Successful’

Approached for comment, Professor Kevin Harrington, from the Institute of Cancer Research, London, and a member of the ESMO CoCARE Registry Steering Committee, said that the UKCCMP has been “fantastically successful”.

He told Medscape News UK that that the team have already published “very impactful papers in The Lancet and in Lancet Oncology “, and their insights into cancer patients affected by COVID-19 have been “really helpful and really informative”.

Prof Harrington said that the increase in mortality seen so far in the UKCCMP among cancer patients affected by COVID-19 is “something like 30%”, which is lower than the 57% increase seen in the study by Dr Shaw and colleagues, which may reflect the higher patient numbers in the UKCCMP.

“But having said that, the group of patients with cancer are heavily overrepresented in terms of more elderly patients,” he continued. “Male patients have a worse outcome…and many of the patients have comorbidities.

“So it’s difficult to pick apart. Is it purely cancer per se that’s leading to the bad outcome, or is it the coexisting high-risk features such as age and comorbidities that are associated with that?”

Prof Harrington highlighted that the UKCCMP has also shown that cancer patients infected with COVID-19 do not have a worse outcome when on active anti-cancer therapies.

“That’s really important because it tells us what we should be doing about treating patients who have active cancers, and we should almost certainly be continuing their anti-cancer therapies.”

The UKCCMP study was funded by the University of Birmingham and University of Oxford.

Dr Olsson-Brown is an MRC Clinical Training Fellow based at the University of Liverpool supported by the North West England Medical Research Council Fellowship Scheme in Clinical Pharmacology and Therapeutics, which is funded by the Medical Research Council, Roche Pharma, Eli Lilly and Company Limited, UCB Pharma, Novartis, the University of Liverpool and the University of Manchester. She has received honoraria from BMS, MSD and Roche.

No other competing interests declared.

ESMO Virtual Congress 2020: Abstracts 1703P, 1704P & 1734P. Presented September 19.

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