Evidence Update – Covid-19 in patients with Thoracic Malignancies

Speciality Trainee in Medical Oncology Dr Ashley Pheely gives an update on some recent evidence about Covid-19 in patients with cancer

TERAVOLT STUDY- COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study M Garassino et al

Background: initial data released in March 2020 from Wuhan, China suggested that patients with cancer, and in particular those on active treatment, were inherently at a higher risk of severe infection with SARS-COV-2 compared to the general population. This study was however limited to a very small sample size of 12 patients. It did pose the important question of whether cancer patients were at an increased risk of severe COVID19 infection and if so, which sub-groups were more likely to have poor outcomes. The TERAVOLT study is a global registry collecting data from patients with thoracic malignancy that have SARS-CoV-2 infection to try and understand the implications of the infection on this cohort of patients. This is an initial analysis from the first 200 patients registered.

Method: the eligibility criteria were patients with a thoracic malignancy (majority had NSCLC); with a diagnosis of COVID19 (majority through RT-PCR but radiological diagnosis and symptoms and with SARS-CoV-2 exposure were also included). Basic demographic characteristics, including age, sex, smoking status, race, stage of disease, type of thoracic malignancy, current oncological treatment, comorbidities, concomitant medications, method for COVID-19 diagnosis, and need for hospital admission (including ICU admission and length of stay) were captured.

Results: the median age of patients was 68. The majority of patients were white, male, current or former smokers with stage IV NSCLC. 147 patients had stage IV NSCLC and 144 were receiving SACT at the time of SARS-CoV-2 diagnosis. 84% of patients had some other co-morbidity with COPD and hypertension being the most common. 154 of the 200 patients were admitted to hospital. 134 (88%) of these patients met the criteria for ICU admission but only 13 (10%) were accepted – in the majority of cases because it was deemed inappropriate to escalate to this level of care in patients with advanced thoracic cancer. Of the 66 (33%) of patients who died 52 (79%) died from complications of COVID19. Univariable analyses revealed that being older than 65 years, being a current or former smoker, receiving treatment with chemotherapy alone and the presence of any comorbidities were associated with increased risk of death. In multivariable analysis for risk of death, only smoking history was associated with increased risk of death.

Conclusion: the initial analysis of the first 200 patients with thoracic malignancy and a diagnosis of COVID19 demonstrated a mortality rate of 33%. The data did not suggest that being on systemic therapy affect survival in patients with COVID-19. TKIs alone were at decreased risk for hospitalisation, and despite initial concerns of increased mortality, immunotherapy did not worsen outcomes for these patients. It is however of note that previous studies have suggested that increased exposure to healthcare settings increases the risk of contracting SARS-CoV-2. Poorer outcomes were seen in the elderly, smokers and the presence of other co-morbidities.

As the study was run by medical oncologists it is of note that patients receiving radiotherapy or surgery for thoracic malignancy were not included in this analysis.