Clinical Portrait of the SARS-CoV-2 Epidemic in European Patients with Cancer

Abstract

The SARS-CoV-2 pandemic significantly affected oncology practice across the globe. There is uncertainty as to the contribution of patients' demographics and oncologic features to severity and mortality from COVID-19 and little guidance as to the role of anticancer and anti-COVID-19 therapy in this population. In a multicenter study of 890 patients with cancer with confirmed COVID-19, we demonstrated a worsening gradient of mortality from breast cancer to hematologic malignancies and showed that male gender, older age, and number of comorbidities identify a subset of patients with significantly worse mortality rates from COVID-19. Provision of chemotherapy, targeted therapy, or immunotherapy did not worsen mortality. Exposure to antimalarials was associated with improved mortality rates independent of baseline prognostic factors. This study highlights the clinical utility of demographic factors for individualized risk stratification of patients and supports further research into emerging anti-COVID-19 therapeutics in SARS-CoV-2-infected patients with cancer. SIGNIFICANCE: In this observational study of 890 patients with cancer diagnosed with SARS-CoV-2, mortality was 33.6% and predicted by male gender, age ≥65, and comorbidity burden. Delivery of cancer therapy was not detrimental to severity or mortality from COVID-19. These patients should be the focus of shielding efforts during the SARS-CoV-2 pandemic. Research.

COVID-19 in cancer patients on systemic anti-cancer therapies: outcomes from the CAPITOL (COVID-19 Cancer PatIenT Outcomes in North London) cohort study

“…One-third (34%, n = 23) of those infected subsequently died from COVID-19, which is in keeping with current literature on oncology patients. 9,11 The prevalence of COVID-19 in our cohort of patients was 2.5%, a figure eight-fold greater than that reported for the general population matched by location and timeframe. 19 During the same period, the prevalence of COVID-19 was 0.3% in Camden and Enfield (the two north London boroughs in which the hospitals in our study are located).…”

Impact of solid cancer on in-hospital mortality overall and among different subgroups of patients with COVID-19: a nationwide, population-based analysis

“…13 These poor prognostic factors were confirmed by the OnCovid registry, comprising 890 patients, mostly from Italy, Spain and the UK. 14 In our report, we compared the clinical presentation, evolution and outcomes of COVID-19 between patients with and without solid cancer within a nationwide population-based cohort, without any a priori matching. In addition, we evaluated the prognostic effect of cancer among different patient subgroups, allowing a more ‡Excluding the presence of cancer as a comorbidity.…”

COVID-19 and Cancer: Current Challenges and Perspectives

“…Beyond the type of cancer, it is also the status of the tumor (active, stable or progressing, or in remission) that seems to influence the prognosis of patients with cancer who develop COVID-19. Patients with advanced cancer as well as progressing diseases have been consistently found to have worse outcomes (compared with those with localized disease or who are in remission) (Albiges et al, 2020;Dai et al, 2020;Kuderer et al, 2020;Passamonti et al, 2020;Pinato et al, 2020;Tian et al, 2020). It is thus far unclear whether this association is due to the general poorer health status of patients with more advanced cancer disease, affecting treatment strategies adopted while driven by the cancer prognosis (e.g., earlier referral to comfort-based care), or whether advanced or progressing cancers affect the COVID-19 disease course due to intersecting biological mechanisms with SARS-CoV-2, as discussed above.…”

“…Receipt of Systemic Cancer-Targeted Therapy. As discussed above, some general guiding principles have emerged with regard to systemic cancer-targeted therapies (Schrag et al, CCC19 (Kuderer et al, 2020) UKCCMP (Lee et al, 2020a(Lee et al, , 2020c OnCovid (Pinato et al, 2020) TERAVOLT (Garassino et al, 2020) Nature Cancer 2020 (Albiges et al, 2020) Nature Medicine 2020 (Robilotti et al, 2020) Cancer Discovery 2020 (Dai et al, 2020) Lancet Oncology 2020 (Tian et al, 2020) Lancet Hematology 2020 (Passamonti et al, 2020)…”

“…Patients with cancer have been found to have particularly adverse outcomes with COVID-19 (Garassino et al, 2020;Giannakoulis et al, 2020;Kuderer et al, 2020;Pinato et al, 2020;Rivera et al, 2020;Saini et al, 2020;Westblade et al, 2020). Moreover, care delivery for chronic conditions, including cancer, has been at least partially disrupted during the peaks of the pandemic due to prioritization and limitations on resources.…”