Risk factors for COVID-19 severity and mortality among solid cancer patients and its impact on anticancer treatment: a nationwide cohort study (GCO-002 CACOVID-19)

Lièvre, Astrid; Turpin, Anthony; Ray-Coquard, Isabelle; Le Malicot, Karine; Thariat, Juliette; Ahle, Guido; Neuzillet, Cindy; Paoletti, Xavier; Bouché, Olivier; Aldabbagh, Kais; Michel, Pierre; Debieuvre, Didier; Canellas, Anthony; Wislez, Marie; Laurent, Lucie; Mabro, May; Colle, Raphael; Hardy-Bessard, Anne-Claire; Mansi, Laura; Colomba, Emeline; Bourhis, Jean; Gorphe, Philippe; Pointreau, Yoann; Idbaih, Ahmed; Ursu, Renata; Di Stefano, Anna Luisa; Zalcman, Gérard; Aparicio, Thomas

BACKGROUND: Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. PATIENTS AND METHODS: In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and June 11, 2020. The primary endpoint was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary endpoints. RESULTS: From April 4 to June 11, 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18-2.52), ECOG PS ≥ 2 (OR 3.23, 95%CI: 2.27-4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01-1.16) and admission to ICU (OR 3.62, 95%CI 2.14-6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except cytotoxic chemotherapy in the subgroup of patients with detectable SARS-CoV-2 by RT-PCR, which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00-2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment interrupted or stopped following diagnosis of COVID-19. CONCLUSIONS: Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis.