key: cord-0886764-fa6j1z9k
authors: Pinato, D. J.; Sng, C.; Wong, Y.N.S.; Biello, F.; Seguí, E.; Aguilar-Company, J.; Carbo Bague, A.; Patriarca, A.; Bower, M. D.; Rizzo, G.; Bruna, R.; Cruz, C. A.; D'Avanzo, F.; Newsom-Davis, T.; Mollà, M.; Gaidano, G.; Brunet, J.; Tabernero, J.; Prat, A.; Gennari, A.
title: Determinants of mortality from SARS-CoV-2 infection in European cancer patients
date: 2020-09-30
journal: Annals of Oncology
DOI: 10.1016/j.annonc.2020.08.1743
sha: 887f72a038f5cdcedf99cef9ba494037e1a6170c
doc_id: 886764
cord_uid: fa6j1z9k

nan

The cancer community of the United Kingdom (UK) has launched the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effect of COVID-19 on cancer patients.

Results: An analysis of the first 800 cancer patients with symptomatic COVID-19 disease entered into the UKCCMP registry has been performed. Approximately half of these patients have a mild COVID-19 disease course (52%). Mortality was observed in 226 patients (28%) and risk of death was significantly associated with advancing patient age, sex (M>F) and the presence of other co-morbidities. Approximately one third had received cytotoxic chemotherapy within 4 weeks prior to testing positive for COVID-19. After adjusting for age, sex and comorbidities, recent receipt of chemotherapy had no significant effect on mortality from COVID-19 disease, when compared to cancer patients who had not received recent chemotherapy. No significant effect on mortality was also observed for patients with recent immunotherapy, hormonal therapy, targeted therapy or radiotherapy use.

Conclusions: Mortality from COVID-19 in cancer patients appears to be principally driven by age, sex and co-morbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anti-cancer treatment are at significantly increased risk of mortality from COVID-19 disease compared to those not on active treatment.

Legal entity responsible for the study: Gary Middleton.

Funding: University of Birmingham. Background: The severity of SARS-CoV-2 infection (COVID-19) is predicted by advancing age and co-morbidities. The relative contribution of cancer in influencing the course of COVID-19 is poorly understood. We designed the OnCOVID study to investigate natural history of COVID-19 disease in cancer patients.

Methods: This retrospective, multi-center observational study conducted across 8 tertiary centers in Europe recruited cancer patients aged >/¼ 18 and diagnosed with COVID-19 between February 26 th and April 1 st , 2020. Descriptive statistics, univariable and multivariable Cox regression models were used to assess patient's main characteristics and to evaluate the factors associated to COVID-19 related mortality.

We identified 204 patients from United Kingdom (n¼97, 48%), Italy (n¼56, 27%) and Spain (n¼51, 25%). Most patients were male (n¼127, 62%) had a diagnosis of solid malignancy (n¼184, 91%) and 103 (51%) had non-metastatic disease. Mean (AESD) patient age was 69AE13 years, and 161 (79%) had >/¼ 1 co-morbidity, most commonly hypertension (n¼88, 43%) and diabetes (n¼46, 23%). Commonest presenting symptoms were fever (n¼136, 67%) and cough (n¼119, 58%), beginning 3.8 (AE4.5 SD) days before diagnosis. Most patients (n¼141, 69%) had >/¼ 1 complication from COVID-19, including respiratory failure (n¼128, 63%) and acute respiratory distress syndrome (n¼49, 24%). In total, 36 patients (19%) patients were escalated to high-dependency or intensive care. At time of analysis, 59 patients had died (29%), 53 were discharged from hospital (26%) and 92 (45%) were in-hospital survivors. Mortality was higher in patients aged >/¼ 65 (36% versus 16%), in those with >/¼ 2 comorbidities (40% versus 18%) and developing >/¼ 1 complication from COVID-19 (38% versus 4%, p¼0.004). Multi-variable analyses confirmed age >/¼ 65 and >/¼ 2 co-morbidities to predict for patient mortality independent of tumor stage, active malignancy or anti-cancer therapy.

Conclusions: In the early outbreak of SARS-CoV-2 infection in Europe co-morbid burden and advancing age predicted for adverse disease course in cancer patients. Risk stratification based on these factors should inform personalized oncological decision making during the COVID-19 pandemic.

Legal entity responsible for the study: Imperial College London.

Funding: Has not received any funding.

Disclosure: D.J. Pinato: Speaker Bureau/Expert testimony, received lecture fees : ViiV Healthcare;

Expert testimony, received lecture fees : Bayer Healthcare; Travel/Accommodation/ Expenses: BMS; Advisory/Consultancy: Mina Therapeutics; EISAI

Advisory/Consultancy: Takeda; Sanofi. G. Gaidano: Advisory/Consultancy, Speaker Bureau/Expert testimony: Janssen; Abbvie; Advisory/Consultancy: AstraZeneca

Advisory/Consultancy: MSD

Advisory/Consultancy: Array Biopharma

Inflection Biosciences Limited; Ipsen; Kura; Lilly; MSD

Merck Serono; Merrimack; Merus; Molecular Partners; Novartis; Peptomics

Advisory/Consultancy: Pfeizer; Honoraria (self), Advisory/ Consultancy, Research grant/Funding (self): Novartis

Honoraria (self): MSD Oncology

Travel/Accommodation/Expenses: Daiichi Sankyo; Advisory/Consultancy: BMS

Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (self): Roche

Advisory/Consultancy: Pierre Fabre; MSD

Expert testimony: Daiichi Sankyo; Speaker Bureau/ Expert testimony: Teva; Gentili; Pfizer; AstraZeneca

All other authors have declared no conflicts of interest

1680P SARS-CoV-2 infections in outpatients with cancer: Most infected patients are asymptomatic carriers without impact on chemotherapy

Haemotology Oncology

It is still unclear whether oncological patients harbor a higher risk for an infection with the SARS-CoV-2 and for developing severe forms of COVID-19

Furthermore, it is unclear whether an infection affects essential therapy treatment and if a therapy increases the risk for an infection

Methods: We tested every patient (n¼1286) in 7 different oncology outpatient clinics from 04/15/2020 and 04/26/2020 for COVID-19 infection regardless of whether symptoms were present or not. Virus RNA was extracted using the MGIEasy extraction kit in combination with SP-960 robots and a RT qPCR was performed

Noteworthy is the fact that 22 (55%) of the positively tested patients were undergoing systemic therapy of which 10 (45.5%) patients received chemotherapy and 4 (18.2%) patients received immunomodulating antibodies. Conclusions: A consequent testing for COVID-19 in cancer patients is obligate to identify asymptomatric positive carrier to separate this potential vector group from COVID negative patients since the majority (37/40) of positive patients was asymptomatic virus-carriers (92,5 %). The data we collected contrasts strongly the hypothesis that cancer patients are suspected to be highly vulnerable for SARS-CoV-2 infections. Only a minority (3/40) of positively tested tumor patients showed symptoms. An asymptomatic COVID-19 infection seems to have no impact on the further course of a chemotherapy