NEW YORK (Reuters Health) – Certain malignancies and their consequences are associated with higher rates of severe or critical COVID-19 illness, but recent cytotoxic chemotherapy is not, according to new research.
“There is a lot of detail we allude to in our paper that just scratches the surface of how cancer types, therapy, and COVID-19 interact,” Dr. Melissa S. Pessin of Memorial Sloan Kettering Cancer Center, in New York City, told Reuters Health by email. “However, it is important for patients to seek cancer therapy and their oncologists not to delay treatment, as we have been seeing patients delay care and present at more advance stages.”
While several reports have suggested that certain malignancies are associated with higher rates of COVID-19-related death and intensive-care unit (ICU) admission, the effect of recent cancer treatment on the course of COVID-19 remains unclear.
Dr. Pessin and colleagues retrospectively reviewed the clinical characteristics and outcomes of 309 patients with confirmed SARS-CoV-2 infection.
Of these patients, 47.6% were admitted to a hospital, 10.0% died, and 38.8% developed the primary endpoint of severe or critical COVID-19. In comparison, in a time-matched group of patients who tested negative for SARS-CoV-2, 33.0% were admitted, 6.2% died and 17% had severe or critical illnesses.
Treatment with cytotoxic chemotherapy or immunotherapy within 35 days of COVID-19 diagnosis was not associated with severe or critical COVID-19, the team reports in the Journal of Clinical Oncology.
In contrast, the diagnosis of hematologic malignancy was associated with a 90% increased risk of severe or critical COVID-19, and lung cancer was associated with a 2.00-fold increased risk of severe or critical COVID-19.
Lymphopenia around the time of COVID-19 diagnosis was associated with a 2.10-fold increased risk of severe or critical COVID-19, and baseline neutropenia was associated with a 4.20-fold risk increase.
Among patients who develop severe or critical COVID-19 infection, there were significant elevations in absolute neutrophil count, interleukin-6, lactate dehydrogenase, D-dimer, aspartate transaminase, troponin I, and procalcitonin at the time of COVID-19 diagnosis.
More than half of the patients with a history of thromboembolism (20/36, 55.6%) developed severe or critical COVID-19.
“As this pandemic progresses, we continue to learn more about the COVID-19 illness and how it can trigger strong inflammatory and coagulopathic conditions in these patients, not all that different from what we can see in metastatic cancer,” Dr. Pessin said. “Thus, one must be cautious using laboratory test markers of inflammation and coagulopathy in cancer patients with COVID-19 to predict or identify severity of COVID-19 illness.”
Dr. Lennard Y. Lee of the University of Birmingham, in the U.K., who recently reported on COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments, told Reuters Health by email, “It was previously believed that if a cancer patient was on chemotherapy and got COVID-19, they would be at very high risk of death. Many oncologists were fearful of administrating chemotherapy during the pandemic in case their patient got COVID-19 and died as a result of their actions. Most interesting from this study is that chemotherapy is not a risk factor for COVID-19 mortality.”
“It means that if cancer patients need chemotherapy, as long as steps are taken to reduce their risk of getting SARS-CoV-2, they should have no barriers to seeing oncologists and getting their treatments,” he said.
“These results are relatively reassuring, in that the majority of cancer patients who develop COVID-19 will not die from this illness,” said Dr. Lee, who was not involved in the study. “The mortality was 1 in 10. Cancer patients with COVID-19 can be treated relatively aggressively to help them to clear this virus.”
He added, “Fear about COVID-19 should not cause physicians to forget that many patients are dependent on their anti-cancer treatments. We must not forget that cancer will not stop occurring or growing during this pandemic.”
Dr. Rohit Gosain of Roswell Park Comprehensive Cancer Center, in Buffalo, New York, who recently reviewed COVID-19 and cancer, told Reuters Health by email, “We are aware that cancer patients are a sensitive population that we deal with. These patients are often elderly, on immunosuppressant medications, and cancer adds that extra layer of complication. So overall the management has not changed, but prior to this study, we have always had our cancer patients be more diligent, extra careful around bigger crowds, often avoid such instances, but if can’t be avoided then take extra precautions of washing hands, staying away from sick patients, wearing masks at all times.”
“In terms of this manuscript, it reported only 18 patients on immunotherapy,” he noted. “We are in this era where immunotherapy is being used in every aspect of cancer care. It would be interesting to see a large cohort of this patient population who are on immunotherapy and COVID-19 diagnosis at hand.”
SOURCE: https://bit.ly/2G0aLRH Journal of Clinical Oncology, online August 14, 2020.