Marina Chiara Garassino, MD
Early data from TERAVOLT, a global registry collecting characteristics and outcomes of patients with thoracic cancers affected by COVID-19, suggested an unexpectedly high mortality among this patient population, Marina Chiara Garassino, MD, said in a virtual presentation during the 2020 AACR Virtual Annual Meeting I.1
Specifically, among patients with thoracic cancers, a 34.6% death rate (n = 66/191) was reported in this first large data set. Additionally, the most frequent complications observed in patients was pneumonia and pneumonitis in 79.6% (n = 125/157), acute respiratory distress syndrome (ARDS) in 26.8% (n = 42/157), multiorgan failure in 7.6% (n = 12/157), and sepsis in 5.1% (n = 8/157). Notably, the cause of death in the large majority of these patients was attributed to COVID-19 infection—not their cancer.
"Our data suggest an unexpectedly high mortality among patients with thoracic cancers, with a 34.6% death rate. The cause of death in the large majority is attributed to COVID-19 infection and not to cancer; we have checked it case by case," said Garassino, a medical consultant in the Medical Oncology Division at Fondazione IRCCS Istituto Nazionale dei Tumori, in Milan, Italy. "Additionally, no comorbidities were significantly associated with a higher risk of death and no anticancer treatments were associated with higher mortality."
First discovered at the end of 2019 in China, COVID-19 has since rapidly spread throughout the Western world. In March 2020, the World Health Organization (WHO) declared the situation to be a pandemic.2
As of April 28, 2020, WHO reported a total of 2,954,222 confirmed cases and 202,597 total deaths.3
However, according to Garassino, the real numbers of new cases are unknown since potentially half of patients infected with the virus are asymptomatic, and thus, a majority of these patients are not being tested.
Early reports from China have suggested that patients with cancer who are infected with COVID-19 are at an increased risk of death. For example, in 1 study of 1099 patients with COVID-19, 23.7% were also noted to have had comorbidities, such as cardiovascular disease (3.9%), diabetes (7.4%), cancer (0.9%), and chronic obstructive pulmonary disease (1.1%).4
Another study showed that in 1590 patients with COVID-19, there was higher incidence of intensive care unit (ICU) admissions and/or mortality specifically in patients with cancer, which was a prevalence of 1%.5
Lastly, in 1524 patients with cancer, COVID-19 was found in 12 (0.79%) patients; half of them were on active therapy, 7 had non–small cell lung cancer (NSCLC), and 4 patients died.6
These data suggest higher prevalence of the virus in patients with cancer compared with the general population, said Garassino.
Another meta-analysis indicated that the pooled prevalence of the virus in patients with cancer was as high as 2.0% (95% CI, 2.0%-3.0%; I2 = 83.2%).7
A further subgroup analysis based on sample size showed that prevalence was slightly higher, at 3.0% (95% CI, 1.0%-6.0%). Garassino noted that larger studies of more than 100 patients have indicated an overall prevalence of 2.0%.
"We must consider patients with cancer and cancer survivors as an important, vulnerable population for COVID-19 contamination," stressed Garassino. "I think that it's very important to try to identify those patients who are at higher risk of COVID-19. Otherwise, in an attempt to reduce the risk of COVID-19 infection, we can potentially increase the risk of cancer and the cancer mortality."
Patients with thoracic malignancies and COVID-19 are thought to be at particularly high risk given the number of potential risk factors such as older age, smoking habit, pre-existing cardiopulmonary concomitant comorbidities, and intensive therapies administered to treat their illness.1
For this reason, physicians from all over the world have come together to contribute to the TERAVOLT registry. The goals of the consortium are to provide data that inform guidance for oncology professionals on how to best manage patients with thoracic malignancies, and develop a stronger understanding of the risk factors associated with morbidity and mortality from the virus.
"Things are moving very quickly; we are registering about 70 new cases per week from all over the world, and many centers decided to join this registry," said Garassino. "It is very important to also recognize the value of scientific societies because they endorse the project and they spread participation to the registry. As a result, we have now 21 countries in all continents [participating]."