Association of Clinical Factors and Recent Anti-Cancer Therapy with COVID-19 Severity among Patients with Cancer: A Report from the COVID-19 and Cancer Consortium

Grivas, P.; Khaki, A.R.; Wise-Draper, T.M.; French, B.; Hennessy, C.; Hsu, C.-Y.; Shyr, Y.; Li, X.; Choueiri, T.K.; Painter, C.A.; Peters, S.; Rini, B.I.; Thompson, M.A.; Mishra, S.; Rivera, D.R.; Acoba, J.D.; Abidi, M.Z.; Bakouny, Z.; Bashir, B.; Bekaii-Saab, T.; Berg, S.; Bernicker, E.H.; Bilen, M.A.; Bindal, P.; Bishnoi, R.; Bouganim, N.; Bowles, D.W.; Cabal, A.; Caimi, P.F.; Chism, D.D.; Crowell, J.; Curran, C.; Desai, A.; Dixon, B.; Doroshow, D.B.; Durbin, E.B.; Elkrief, A.; Farmakiotis, D.; Fazio, A.; Fecher, L.A.; Flora, D.B.; Friese, C.R.; Fu, J.; Gadgeel, S.M.; Galsky, M.D.; Gill, D.M.; Glover, M.J.; Goyal, S.; Grover, P.; Gulati, S.; Gupta, S.; Halabi, S.; Halfdanarson, T.R.; Halmos, B.; Hausrath, D.J.; Hawley, J.E.; Hsu, E.; Huynh-Le, M.; Hwang, C.; Jani, C.; Jayaraj, A.; Johnson, D.B.; Kasi, A.; Khan, H.; Koshkin, V.S.; Kuderer, N.M.; Kwon, D.H.; Lammers, P.E.; Li, A.; Loaiza-Bonilla, A.; Low, C.A.; Lustberg, M.B.; Lyman, G.H.; McKay, R.R.; McNair, C.; Menon, H.; Mesa, R.A.; Mico, V.; Mundt, D.; Nagaraj, G.; Nakasone, E.S.; Nakayama, J.; Nizam, A.; Nock, N.L.; Park, C.; Patel, J.M.; Patel, K.G.; Peddi, P.; Pennell, N.A.; Piper-Vallillo, A.J.; Puc, M.; Ravindranathan, D.; Reeves, M.E.; Reuben, D.Y.; Rosenstein, L.; Rosovsky, R.P.; Rubinstein, S.M.; Salazar, M.; Schmidt, A.L.; Schwartz, G.K.; Shah, M.R.; Shah, S.A.; Shah, C.; Shaya, J.A.; Singh, S.R.K.; Smits, M.; Stockerl-Goldstein, K.E.; Stover, D.G.; Streckfuss, M.; Subbiah, S.; Tachiki, L.; Tadesse, E.; Thakkar, A.; Tucker, M.D.; Verma, A.K.; Vinh, D.C.; Weiss, M.; Wu, J.T.; Wulff-Burchfield, E.; Xie, Z.; Yu, P.P.; Zhang, T.; Zhou, A.Y.; Zhu, H.; Zubiri, L.; Shah, D.P.; Warner, J.L.; Lopes, G. dL.

BACKGROUND: Patients with cancer may be at high risk of adverse outcomes from SARS-CoV-2 infection. We analyzed a cohort of patients with cancer and COVID-19 reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anti-cancer therapies. PATIENTS AND METHODS: Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between March 17-November 18, 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anti-cancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS: 4,966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2,872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic Black race, Hispanic ethnicity, worse ECOG performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count, high absolute neutrophil count, low platelet count, abnormal creatinine, troponin, LDH, and CRP were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anti-cancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS: Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anti-cancer therapies.