Patients with cancer are a particularly vulnerable population in the COVID-19 pandemic. The COVID-19 and Cancer Consortium (CCC19) was formed in March, 2020 with the goal of studying the clinical characteristics and course of illness among patients with COVID-19 and cancer. These observational data provide an overview of clinical practice in the ‘’real world’’ setting given the lack of data from randomized controlled trials. The primary analysis from the CCC19 registry database study revealed that patients with active or prior cancer are at an increased risk of mortality and severe illness within 30 days of COVID-19 diagnosis. Factors associated with increased mortality include increasing age, male sex, smoking history, number of comorbidities, ECOG performance status ≥2, active cancer, and treatment with a combination of azithromycin and hydroxychloroquine.

The aim of a recently published follow-up study by the CCC19 was to investigate the association between various COVID-19 treatments and 30-day all-cause mortality in patients with active or prior cancer, and to identify factors associated with the receipt of treatments. The study included a cohort of 2,186 patients with cancer and laboratory-confirmed SARS-CoV-2 infection who were treated with (alone or in combination) hydroxychloroquine, azithromycin, remdesivir, high-dose corticosteroids (e.g. dexamethasone), the IL-6 inhibitor tocilizumab, and other or no therapy. There was a high variability in the prescribed treatments, depending on the patient, prescriber and access factors, and all treatments, apart from remdesivir, were used outside a clinical trial setting. The median follow-up at the time of analysis was 30 days. The mortality rate was 16% compared with 13% in the first CCC19 cohort study. The data showed no evidence of clinical benefit with any treatment, except with remdesivir. Remdesivir was the only agent that reduced mortality when compared with patients who received any other treatment, although this result was not statistically significant. Importantly, hydroxychloroquine in combination with any other drug was associated with increased mortality. Unfortunately, the encouraging findings from the British open label randomized RECOVERY trial that showed a clinical benefit with dexamethasone in critically ill patients (ventilated patients and those receiving oxygen), were not replicated in patients with cancer and COVID-19. Used alone, high-dose corticosteroids were numerically associated with increased mortality; furthermore, patients who received high-dose corticosteroids with any other potential COVID-19 treatment had an increased mortality rate compared with patients who were untreated or treated with other medications. This negative effect of corticosteroids may arise from the immunocompromised state of patients with cancer. Tocilizumab was rarely used and therefore its real effect could not be evaluated in this study. Regarding the factors affecting receipt of treatment, the study showed that patients with increased baseline COVID-19 severity, males, obese patients and patients with hypertension were more likely to receive treatment. Treatment with remdesivir was less likely in patients with renal impairment. In addition, the data indicated that black patients received remdesivir approximately half as often as white patients.

These updated CCC19 observational study data indicate that the ‘’real world’’ pattern of care for patients with cancer and COVID-19 varies substantially. The data support the need for further evaluation of treatments for patients with COVID-19 and cancer in randomized controlled trials, with a concerted effort to include patients from racially diverse backgrounds.

Reference

Rivera DR, et al. Cancer Discovery 2020; July 22 [Epub ahead of print].