COVID-19 in patients with lung cancer

Luo, Jia; Rizvi, Hira; Preeshagul, Isabel R.; Egger, Jacklynn V.; Hoyos, David; Bandlamudi, Chaitanya; McCarthy, Caroline G.; Falcon, Christina J.; Schoenfeld, Adam J.; Arbour, Kathryn C.; Chaft, Jamie E.; Daly, Robert M.; Drilon, Alexander; Eng, Juliana; Iqbal, Afsheen; Lai, W. Victoria; Li, Bob T.; Lito, Piro; Namakydoust, Azadeh; Ng, Kenneth; Offin, Michael; Paik, Paul K.; Riely, Gregory J.; Rudin, Charles M.; Yu, Helena A.; Zauderer, Marjorie G.; Donoghue, Mark T.A.; Łuksza, Marta; Greenbaum, Benjamin D.; Kris, Mark G.; Hellmann, Matthew D.

BACKGROUND: Patients with lung cancers may have disproportionately severe COVID-19 outcomes. Understanding the patient-specific and cancer-specific features that impact severity of COVID-19 may inform optimal cancer care during this pandemic. PATIENTS AND METHODS: We examined consecutive patients with lung cancer and confirmed diagnosis of COVID-19 (n=102) at a single center from March 12-May 6, 2020. Thresholds of severity were defined a priori as hospitalization, ICU/intubation/DNI (a composite metric of severe disease including ICU stay, intubation and invasive mechanical ventilation, and/or transition to do not intubate [DNI]), or death. Recovery was defined as >14 days from COVID-19 test and >3 days since symptom resolution. HLA alleles were inferred from MSK-IMPACT (n=46) and compared to controls with lung cancer and no known non-COVID-19 (n=5166). RESULTS: COVID-19 was severe in patients with lung cancer (62% hospitalized, 25% died). Although severe, COVID-19 accounted for a minority of overall lung cancer-deaths during the pandemic (11% overall). Determinants of COVID-19 severity were largely patient-specific features, including smoking status and chronic obstructive pulmonary disease (Odds ratios for severe COVID-19 2.9, 95% CI 1.07-9.44 comparing the median [23.5 pack-years] to never and 3.87, 95% CI 1.35-9.68, respectively). Cancer-specific features, including prior thoracic surgery/radiation and recent systemic therapies did not impact severity. HLA supertypes were generally similar in mild or severe cases of COVID-19 compared to non-COVID-19 controls. Most patients recovered from COVID-19, including 25% patients initially requiring intubation. Among hospitalized patients, hydroxychloroquine did not improve COVID-19 outcomes. CONCLUSION: COVID-19 is associated with high burden of severity in patients with lung cancer. Patient-specific features, rather than cancer-specific features or treatments, are the greatest determinants of severity.