Chemotherapy Use in Patients with Thoracic Cancer and COVID-19 Linked to Increased Risk of Death

New findings suggest that patients with thoracic cancer who receive chemotherapy three months after a COVID-19 diagnosis may have an increased risk of death compared to similar patients who underwent different treatment.

Patients with lung and other thoracic cancers who have received chemotherapy within three months of being diagnosed with COVID-19 may have an increased risk of death compared to patients who have received other treatment methods, according to an analysis presented during a 2020 ASCO Virtual Scientific Program press briefing.

Patients with lung or other thoracic malignancies, including mesothelioma, thymic neoplasms, and carcinoid tumors, are considered to be at a higher risk of contracting COVID-19 due to their age, comorbidities, pre-existing lung damage, and the fact that they are more likely to be on cancer-fighting medication that may compromise the immune system.

Because of this, and the fact that previous research has found higher mortality rates in patients with cancer who are infected with COVID-19, researchers created an international database, named the Thoracic cancERs international coVid 19 cOLlaboraTion (TERAVOLT) registry, to further examine the impact of a COVID-19 diagnosis on these individuals. After its establishment in late March, oncologists from around the world were then invited to enter their data.

As of May 8, 400 patients with thoracic malignancies and COVID-19 were included in the analysis presented at the meeting. The majority of patients were males with stage 4 cancer, between 66.5 and 70 years of age. Additionally, more than half of the patients had non-small cell lung cancer (NSCLC), and a small percentage of all groups were never smokers. The majority of patients were either untreated or on the first line of treatment, at the time of COVID-19 infection.

At data cutoff, 169 patients have recovered, 141 have died, and 118 are still currently in treatment. Of the 141 individuals who died, 79.4% (112) died due to COVID-19, 10.6% (15) died of cancer, while 8.5% (12) died as a result of both cancer and COVID-19. Two deaths were from unknown reasons.

In the three months prior to COVID-19 diagnosis, lead study author Dr. Leora Horn, who is the Ingram Associate Professor of Cancer Research and director of the Thoracic Oncology Program at Vanderbilt University Medical Center, explained during the press briefing that a significant number of patients who later died (45%) were receiving chemotherapy, while 20% of patients who died were receiving immunotherapy, and even smaller percentages were receiving targeted or radiation therapies.

Only the patients treated with chemotherapy within three months of their COVID-19 diagnosis, either alone or in combination with other therapies, had a significantly increased risk (64%) of dying from the virus, vs. patients who did not receive chemotherapy.

The researchers noted that the type of COVID-19 treatment did not appear to be a factor in the risk of death, as the number of patients who died after receiving anticoagulants, antibiotics, antivirals, antifungals, corticosteroids, drugs targeting IL-6, and hydroxychloroquine was the same or similar to the number of patients that recovered.

While these findings offer a better understanding of the risk factors associated with poor outcomes in patients with thoracic cancer who develop COVID-19, the researchers did note that the database is a fluid tool that is constantly evolving as information on COVID-19 is discovered.

“A number of factors — pre-existing lung damage, smoking status, advanced age, and comorbidities — make patients with thoracic cancers especially vulnerable to COVID-19,” said ASCO President Dr. Howard A. Burris III in a press release about the data. “There are a lot of questions right now, and not a lot of answers. These findings give us some insights into outcomes for patients with cancer who develop COVID-19.”