ASCO20 Virtual: Study Assesses COVID-19 Clinical Data, Finds Cancer Mortality Links

May 28, 2020

The findings, which were presented virtually in the 2020 ASCO Virtual Scientific Program, included the association between treatment with hydroxychloroquine plus azithromycin and increased risk of death.

A study presented online for the 2020 American Society of Clinical Oncology (ASCO) Virtual Scientific Program found that mortality was high among patients with cancer affected by coronavirus disease 2019 (COVID-19). Mortality was also associated with both general population risk factors, as well as those unique to patients with cancer.

The study, which is being presented as a late-breaking abstract, also showed that receipt of hydroxychloroquine plus azithromycin was an independent factor associated with increased morality. Lead investigator Jeremy Warner, MD, MS, FAMIA, FASCO, associate professor of medicine and biomedical informatics at Vanderbilt University Medical Center in Nashville, Tennessee, discussed the findings in a virtual press briefing.

Investigators used data from the COVID-19 and Cancer Consortium (CCC19) to assess mortality and severe illness in patients with cancer and severe acute respiratory coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.The survey was initiated on March 17, 2020; the study was open to site-level participation in the United States and Canada, as well as anonymous individuals in Argentina, Canada, European Union, United States, and United Kingdom.

In the presentation, Dr Warner highlighted that there are limited data and published reports available on cancer patients who have contracted COVID-19. Though hydroxychloroquine was authorized by the FDA to treat severe COVID-19 cases, numerous studies have failed to associate the drug with significant positive outcomes.

The survey incorporated 1018 cases accrued March-April 2020 and evaluated demographic data, with a median follow-up of 21 days. Median age of patients was 66 years, and 30% of patients were above the age of 75.

Fifty percent of those assessed were white; 16% black or African American; 16% were Hispanic.

In terms of cancer patient data, 39% of patients were on active anti-cancer treatment, whereas 43% expressed active (measurable) cancer, according to the investigators. Most common cancer types were breast (20%), prostate (16%), gastrointestinal (12%), lymphoma (11%), and thoracic (10%).

Of the patients assessed, 106 (10.4%) died and 26% the composite outcome of death, severe illness requiring hospitalization, and/or mechanical ventilation. Additional demographic data found higher death rates in males, former smokers, patients with ECOG performance status (PS) of 2 or higher, and patients with active progressing cancer.

The study found that patients over the age of 75 who were admitted to the intensive care unit (ICU) demonstrated a mortality rate of 54%, whereas 68% of patients with ECOG PS 2 or above died.

“The CCC19 international registry is an example of the cancer community  quickly coming together to identify and collect data we need on a large scale to better understand what is happening in patients in cancer,” Warner said in the virtual presentation.

The investigators, however, stressed uncertain validity due to the likelihood of residual confounding linked with the data. In future studies, Warner highlighted the need for larger sample sizes and longer follow-ups in order “to better understand the impact of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.”

References:

1. Warner JL, Rubinstein SM, Grivas P, et al. Clinical impact of COVID-19 on patients with cancer: Data from the COVID-19 and Cancer Consortium (CCC19). Presented at: ASCO 2020 Annual Meeting; May 29-31, 2020; online. Accessed May 28, 2020. https://meetinglibrary.asco.org/record/191968/abstract.