SARS-CoV-2 is associated with diverse clinical presentations ranging from asymptomatic infection to lethal complications. Small studies have suggested inferior outcomes in patients (pts) on active cancer treatment. This finding was not independently validated in our prior report on 928 pts, which included treatments administered within 4 weeks of COVID-19 diagnosis. Here, we examine outcomes related to systemic cancer treatment within one year of lab-confirmed SARS-CoV-2 infection in an expanded cohort.
The COVID-19 and Cancer Consortium (CCC19) registry (NCT04354701) was queried for pts ever receiving systemic treatment. Treatment type, cancer type, stage, and COVID-19 outcomes were examined. Pts were stratified by time from last treatment administration: <2 wk, 2-4 wk, 1-3 mo, or 3-12 mo. Standardized incidence ratios (SIR) of mortality by treatment type and timing were calculated.
As of 31 July 2020, we analyzed 3920 pts; 42% received systemic anti-cancer treatment within 12 mo (Table). 159 distinct medications were administered. The highest rate of COVID-19-associated complications were observed in pts treated within 1-3 months prior to COVID-19; all-cause mortality in this group was 26%. 30-day mortality by most recent treatment type was 20% for chemotherapy, 18% for immunotherapy, 17% for chemoradiotherapy, 29% for chemoimmunotherapy, 20% for targeted therapy, and 11% for endocrine therapy. SIR of mortality was highest for chemoimmunotherapy or chemotherapy <2 wks, and lowest for endocrine treatments. A high SIR was also found for targeted agents within 3-12 mo. Pts untreated in the year prior to COVID-19 diagnosis had a mortality of 14%. *Absolute number of pts <5.
Most recent treatment before COVID-19 <2 wk 2-4 wk 1-3 mo 3-12 mo Chemo 30 46 44 45 Immuno (IO) 7 18 8 10 Chemo-IO 2 6 4 * Targeted 39 32 35 25 Endocrine 32 13 19 14 Solid tumor 63 68 63 59 Hematologic 26 18 24 25 Hospitalized 54 54 61 57 O2 required 41 43 45 41 ICU 14 16 17 13 Mech. ventilation 10 11 13 10 Chemo 1.18 (0.77-1.73) 0.92 (0.59-1.36) 0.92 (0.44-1.69) IO 1.03 (0.51-1.85) 1.02 (0.46-1.93) * * Chemo-IO 2.22 (0.95-4.37) * * * Targeted 0.98 (0.74-1.27) 0.97 (0.54-1.60) 1.41 (0.95-2.03) Endocrine * 0.73 (0.31-1.43) *
30-day mortality was highest amongst cancer pts treated 1-3 months prior to COVID-19 diagnosis and those treated with chemoimmunotherapy. Except for endocrine therapy, mortality for subgroups was numerically higher than in pts untreated within a year prior to COVID-19 diagnosis.
NCT04354701.
The COVID-19 and Cancer Consortium (CCC19).
National Cancer Institute (P30 CA068485).
T.M. Wise-Draper: Research grant/Funding (self), Travel/Accommodation/Expenses: AstraZeneca; Research grant/Funding (self): BMS; Research grant/Funding (self): Tesaro/GSK; Advisory/Consultancy: Shattuck Labs; Leadership role, Travel/Accommodation/Expenses, HNC POA Lead: Caris Life Sciences; Research grant/Funding (self), Travel/Accommodation/Expenses: Merck; Travel/Accommodation/Expenses: Eli Lilly; Travel/Accommodation/Expenses: Bexion. A. Elkrief: Research grant/Funding (self): AstraZeneca. B.I. Rini: Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Merck; Advisory/Consultancy, Research grant/Funding (self): Roche; Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy, Research grant/Funding (self): AVEO; Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: BMS; Advisory/Consultancy: arravive; Advisory/Consultancy: 3D medicines; Advisory/Consultancy: Synthorx; Advisory/Consultancy: Surface Oncology; Shareholder/Stockholder/Stock options: PTC Therapeutics; Research grant/Funding (self): AstraZeneca. D.B. Johnson: Advisory/Consultancy: Array Biopharma; Advisory/Consultancy, Research grant/Funding (self): BMS; Advisory/Consultancy: Janssen; Advisory/Consultancy: Merck; Advisory/Consultancy: Novartis; Research grant/Funding (self): Incyte; Leadership role: ASCO melanoma scientific committee chair; Leadership role: NCCN Melanoma committee. G. Lopes: Honoraria (self), Travel/Accommodation/Expenses: Boehringer Ingelheim; Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer; Advisory/Consultancy, Research grant/Funding (self), Research grant/Funding (institution): AstraZeneca; Research grant/Funding (institution): Merck; Research grant/Funding (institution): EMD Serono; Research grant/Funding (institution): Blueprint Medicine; Research grant/Funding (institution): Tesaro; Research grant/Funding (institution): Bavarian Nordic; Research grant/Funding (institution): Novartis; Research grant/Funding (institution): GI Therapeutics; Research grant/Funding (institution): adaptimmune; Research grant/Funding (institution): BMS; Research grant/Funding (institution): GSK; Research grant/Funding (institution): AbbVie; Research grant/Funding (institution): Rgenix; Research grant/Funding (institution): Roche; Research grant/Funding (institution): Genentech; Research grant/Funding (institution): Lilly; Research grant/Funding (institution), Travel/Accommodation/Expenses: Janssen; Travel/Accommodation/Expenses: E.R. Squibb Sons LLC. P. Grivas: Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): AstraZeneca; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Bayer; Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (self): BMS; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Clovis Oncology; Honoraria (self), Advisory/Consultancy: Driver; Honoraria (self), Advisory/Consultancy: EMD Serono; Honoraria (self), Advisory/Consultancy: Exelixis; Honoraria (self), Advisory/Consultancy: Foundation Medicine; Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Genentech; Honoraria (self), Advisory/Consultancy: Genzyme; Honoraria (self), Advisory/Consultancy: GSK; Honoraria (self), Advisory/Consultancy: Heron Therapeutics; Honoraria (self), Advisory/Consultancy: Janssen; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Merck; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Mirati Therapeutics; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Pfizer; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: Seattle Genetics; Honoraria (self), Advisory/Consultancy: QED Therapeutics; Honoraria (institution): KureIT; Research grant/Funding (self): Bavarian Nordic; Research grant/Funding (self): Debiopharm; Research grant/Funding (self): Immunomedics; Research grant/Funding (self): Oncogenex. M.A. Thompson: Honoraria (self): AbbVie; Honoraria (self): BMS; Honoraria (self): Crab CTC; Honoraria (self): Denovo; Honoraria (self): Hoosier Research Network; Honoraria (self): Lilly; Honoraria (self): LynxBio; Honoraria (self): Strata Oncology; Honoraria (self), Advisory/Consultancy: Takeda; Honoraria (self): TG Therapeutics; Advisory/Consultancy: Adaptive; Advisory/Consultancy: AIM Specialty Health; Advisory/Consultancy: Cellgene (BMS); Advisory/Consultancy: GSK; Advisory/Consultancy: Via Oncology; Travel/Accommodation/Expenses, Shareholder/Stockholder/Stock options: Doximity; Travel/Accommodation/Expenses: Syapse; Licensing/Royalties: Uptodate. S. Peters: Honoraria (self), Honoraria (institution), Advisory/Consultancy: AbbVie; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self): Amgen; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: AstraZeneca; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Bayer; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Biocartis; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Bioinvent; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Blueprint Medicines; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self): Boehringer-Ingelheim; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Bristol-Myers Squibb; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self): Clovis; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Travel/Accommodation/Expenses: Daiichi Sankyo; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Debiopharm; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Eli Lilly; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: F. Hoffmann-La Roche; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Foundation Medicine; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Ilumina; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Janssen; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Merck Sharp and Dohme; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self): Merck Serono; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Merrimack; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self): Novartis; Honoraria (self), Honoraria (institution), Advisory/Consultancy: PharmaMar; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self): Pfizer; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Regeneron; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Sanofi; Honoraria (self), Honoraria (institution), Advisory/Consultancy, Travel/Accommodation/Expenses: Seattle Genetics; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Takeda; Honoraria (self), Honoraria (institution), Advisory/Consultancy: Vaccibody; Research grant/Funding (self): Biodesix. N.M. Kuderer: Advisory/Consultancy, Travel/Accommodation/Expenses: BMS; Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen; Honoraria (self), Advisory/Consultancy: Celldex; Honoraria (self), Advisory/Consultancy: Invitae; Honoraria (self), Advisory/Consultancy: Total Health; Honoraria (self), Advisory/Consultancy: Beyond Springs; Honoraria (self), Advisory/Consultancy: BAyer; Honoraria (self), Advisory/Consultancy: Spectrum Pharmaceuticals. S. Gulati: Advisory/Consultancy: Puma Biotechnology; Travel/Accommodation/Expenses: ASCO; Research grant/Funding (self): AstraZeneca; Research grant/Funding (self): IsoRay. T.K. Choueiri: Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): AstraZeneca; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Alexion; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Bayer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): BMS; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Cerulean; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Eisai; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Foundation Medicine; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Exelixis; Advisory/Consultancy, Research grant/Funding (self): Ipsen; Research grant/Funding (self): Tracon; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Genentech; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Roche; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): GSK; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Lilly; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Merck; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Novartis; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Peloton; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Pfizer; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Promethius Labs; Advisory/Consultancy, Research grant/Funding (self): Corvus; Research grant/Funding (self): Calithera; Honoraria (self), Advisory/Consultancy, Research grant/Funding (self): Analysis Group; Honoraria (self), Research grant/Funding (self): Sanofi/Aventis; Research grant/Funding (self): Takeda; Honoraria (self): EMD Serono; Honoraria (self): Navinata Healthcare; Honoraria (self), Advisory/Consultancy: NCCN; Honoraria (self): Michael J. Hennessy (MJH) Associates, Inc (Healthcare Communications Company with several brands such as OnClive, PeerView and PER); Honoraria (self): Research to Practice; Advisory/Consultancy: Tempus. J. Warner: Advisory/Consultancy: BM Watson Health; Advisory/Consultancy: westat; Leadership role, Shareholder/Stockholder/Stock options: HemOnc.org LLC; Travel/Accommodation/Expenses: American Society of Clinical Oncology. All other authors have declared no conflicts of interest.