Chemotherapy not associated with an increased COVID-19 mortality risk in active cancer patients

1. This prospective cohort study demonstrated that, in adult patients with active cancer and a clinical diagnosis of COVID-19, recent systemic anticancer treatments were not associated with an increase in overall or COVID-19 specific mortality.

2. Recent immunotherapy was associated with less severe COVID-19 symptoms and a lower mortality rate in active cancer patients.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Patients living with cancer are suggested to have a 2-fold higher risk of COVID-19 related mortality, however the risk of mortality in patients receiving systemic anticancer treatments (SACT) is unknown. This prospective cohort study included 2515 adult cancer patients across 69 UK cancer hospitals between March to August 2020 and examined whether there was an association between SACT and COVID-19 specific mortality. The primary endpoint for this study was all-cause mortality during primary hospitalization. The secondary endpoint was COVID-19 specific mortality. Patients presented with varying levels of COVID-19 symptoms; 44% with mild (n=1108), 28% with severe (n=701), 21% were critical (n=539) and 5% were asymptomatic (n=119). A mortality rate of 38% (n=966) was observed in cancer patients of which, 51% (n=493) presented with critical COVID-19 symptoms. Variables associated with a higher mortality included male sex, older age and the presence of comorbidities. Recent chemotherapy was not associated with an increased all-cause mortality rate in comparison to patients who had either received another form of anticancer treatment or no anticancer treatment. Patients receiving chemotherapy for diagnosed solid cancer, primary cancers, and metastatic cancers, and patients receiving nonpalliative chemotherapy were observed to have a lower mortality. A limitation to this study was that the median follow-up of patients was relatively short (median IQR follow-up for all-cause mortality was 7 days) and did not account for patients whom could have been discharged from the hospital and subsequently died due to COVID-19. A major strength of this study was that it was the first to demonstrate a significant association between immunotherapy treatment and lower mortality in active cancer patients with COVID-19.

Click to read the study in JAMA Network Open

Relevant Reading: Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China

In-Depth [prospective cohort]: This cohort study included 2515 active cancer patients receiving SACT (mean age, 72.0 years; 1464 [58%] male) with a clinical diagnosis of COVID-19. Findings suggest that recent chemotherapy was not associated with an increased all-cause mortality compared to patients who received another form of anticancer treatment (OR: 0.82 [95% CI, 0.62-1.07]) or no anticancer treatment (OR: 0.70 [95% CI, 0.52 -0.94]). Variables associated with a higher mortality included male sex (OR: 1.53 [95%CI, 1.23-1.90]), older age (OR: 1.04 [95% CI, 1.03-1.05]) and the presence of comorbidities (OR: 1.92 [95% CI, 1.57-2.34]). However, after adjusting for age, sex and comorbidities in a population of patients with hematological cancer (n=181) no statistically significant association was found between chemotherapy and mortality (OR: 1.28 [95% CI, 0.85-1.95]). In particular, patients diagnosed with solid cancer undergoing chemotherapy (n=406) were associated with a reduced all-cause mortality rate in comparison to those who were receiving no anticancer treatment (OR: 0.48 [95% CI, 0.36-0.65]). Additionally, primary cancers (n=759, OR: 0.48 [95%CI, 0.30-0.77]; p for heterogeneity = 0.002) and metastatic cancers (n=868, OR: 0.65 [95%CI, 0.45 – 0.93]; p for heterogeneity = 0.02) in patients undergoing chemotherapy were associated with a lower mortality. Patients undergoing nonpalliative chemotherapy were also found to have a lower mortality rate compared with those receiving palliative chemotherapy (OR: 0.44 [95% CI, 0.26-0.76]).

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