High Mortality Rates in Patients With Thoracic Cancer and COVID-19

Patients with non-small cell lung cancer (NSCLC) and other thoracic cancers who also had COVID-19 demonstrated an unexpectedly high mortality rate and were often not offered intensive care, according to early results from the global TERAVOLT registry presented at the American Association for Cancer Research (AACR) Virtual Annual Meeting I 2020.

“With a strong united thoracic community, we were able to activate a global registry and provide preliminary data in only a month,” Marina Chiara Garassino, MD, of the Fondazione IRCCS Istituto Nazionale dei Tumori in Italy, and author of the study, said.

Early reports suggest that patients with cancer and COVID-19 have an increased risk of death, and patients with thoracic cancers may be particularly vulnerable due to common comorbidities and treatments.

“We must consider patients with cancer and cancer survivors as an important vulnerable population for COVID-19 infection,” Dr Garassino said.

Given these concerns, and the global COVID-19 crisis, researchers from Milano, Italy, initiated the TERAVOLT registry to collect data that may help guide patient care by oncology providers. Now, the TERAVOLT registry includes 160 institutions from 20 countries.

This analysis includes data from 200 patients from 8 countries, with a median age of 68 years, 29.5% who are female, and 81.1% are current or former smokers. Comorbidities were present in 83.8% of patients, with the most common including hypertension (47%), chronic obstructive pulmonary disease (25.8%), history of ischemic heart disease (15.2%), and diabetes (14.6%).

The majority of patients had NSCLC (75.5%), followed by small cell lung cancer (14.5%) and other rare thoracic malignancies. Stage IV disease was present in 73.5% of patients. Most patients were receiving active treatment with chemotherapy (32.7%), immune checkpoint inhibitor monotherapy (23.1%), tyrosine kinase inhibitor monotherapy (19%), or combination immunotherapy plus chemotherapy (13.6%).

In this cohort, 12.1% of patients were asymptomatic. Dr Garassino said that “overlapping symptoms of lung cancer and the differential diagnosis [of COVID-19] in these patients is very challenging.” Of patients with symptoms, the most common were fever, cough, dyspnea, and fatigue.

Hospitalization was required for 76% of patients. The most common COVID-19–related complications were pneumonia/pneumonitis (79.6%), acute respiratory distress syndrome (26.8%), multiorgan failure (7.6%), sepsis (5.1%), and coagulopathy (5.1%). Overall, 34.6% of patients died.

Despite the high rate of hospitalizations in this cohort, 8.8% were admitted to the intensive care unit (ICU) and 2.5% were mechanically ventilated. Reasons for not admitting patients who qualified for ICU care included not indicated (90.9%), no resources available (2%), institutional policy (2.0%), and because the patient declined (5.1%). Dr Garassino noted that the low rate of ICU admission was the potential result of “shortages and institutional rules.”

A univariate analysis did not find any comorbidities or anticancer treatments that were associated with higher risk of death. “However … the odds ratio is always more than 1 and we have to do the analysis with more events and more data in the future,” Dr Garassino said.

These early data, Dr Garassino concluded, “suggest an unexpectedly high mortality rate among thoracic cancer patients.”

Reference

Garassino MC. TERAVOLT (Thoracic cancERs international coVid 19 cOLlaboraTion): First results of a global collaboration to address the impact of COVID-19 in patients with thoracic malignancies. Presented at: American Association for Cancer Research (AACR) Virtual Annual Meeting I 2020; April 27-28, 2020.

This article originally appeared on Cancer Therapy Advisor