Recent Chemotherapy Raises COVID-19-Related Mortality Risk for Patients With Thoracic Cancer

Chemotherapy administered within 3 months of a diagnosis of COVID-19 increased the risk of death in patients with thoracic cancer.

Leora Horn, MD, MSc

Leora Horn, MD, MSc, the Ingram Associate Professor of Cancer Research and clinical director of the Thoracic Oncology Program at Vanderbilt University Medical Center

Leora Horn, MD, MSc

Chemotherapy administered within 3 months of a diagnosis of coronavirus disease 2019 (COVID-19) increased the risk of death in patients with thoracic cancer, according to findings from the global TERAVOLT Consortium registry.1

"Prior administration of chemotherapy is associated with increased risk of death [from COVID-19] while immunotherapy and tyrosine kinase inhibitors are not," said Leora Horn, MD, MSc, the Ingram Associate Professor of Cancer Research and clinical director of the Thoracic Oncology Program at Vanderbilt University Medical Center. Horn presented updated findings from the TERAVOLT registry in a press program ahead of the 2020 American Society of Clinical Oncology Virtual Scientific Program.

Early reports of mortality from COVID-19 suggested that patients with cancer had a higher risk of dying from the virus. In order to quantify the risks and improve disease management, investigators set up a database to review the characteristics of patients with thoracic cancers who developed COVID-19.

Horn explained that the idea for the registry went from the idea phase to international review board and was approved within only 1 week. The final protocol was accepted and the first patient was entered into the database on March 20, 2020. Since then, as of the data cutoff on May 8, 2020, 400 patients across more than 25 countries have been entered into the database.

One goal of the TERAVOLT consortium was to determine the demographics, comorbidities, characteristics of the patient's cancer, recent treatments, and other factors that may affect the risk of hospitalization or death in patients who developed COVID-19. Additionally, the investigators sought to understand the clinical course of the infection in patients with thoracic malignancies so that they could provide real-time data on therapeutic approaches to practitioners treating other patients and then evaluate the long-term impact.

Horn noted that all patients with a thoracic malignancy and a COVID-19 diagnosis, as confirmed by real-time polymerase chain reaction testing or radiographic findings, are eligible to enter into the registry.

An initial analysis of findings from the TERAVOLT registry was presented at the 2020 American Association for Cancer Research after a median follow up of 15 days. In this analysis, investigators noted that a majority of the patients included were European (98%), on active therapy (74%), and were hospitalized due to COVID-19 infection (76%).2

Multivariate analysis of this early population showed that only age greater than 65 years was associated with an increased risk of morbidity from COVID-19. Thirty-three percent died due to complications from the virus.

An updated view of the registry included a more global view of the impact of COVID-19 with patients included from US centers and longer duration with a median follow-up of 33 days from the time of COVID-19 diagnosis.1

The updated findings included data from 169 patients who recovered from the infection, 141 who died, and 118 who were still being treated for the infection as of the data cutoff. This accounted for a mortality rate of 35.5% of patients in the TERAVOLT registry who had thoracic malignancies and COVID-19.

In the recovered group, the median age was 67.0 years (range, 59.0-74.0), 63.3% of these patients were male, 56.3% were former smokers, and 61.4% had stage IV disease. The majority of patients (81.9%) had non—small cell lung cancer whereas 9.6% had small cell lung cancer and 8.5% had other thoracic malignancies. As of the last clinic visit, 44.8% of patients had an ECOG performance status score of 0 and 2.4% had a score of at least 2. Treatment for cancer had not yet been received for 22.5% of these patients; 50.9% had received 1 prior line of therapy and 26.6% had received at least 2.

In the group of patients who died from COVID-19—related complications, the median age was 70.0 years (range, 64.0-76.0), 70.2% were male, 65.2% were former smokers, and 75.7% had stage IV disease. About three-quarters of patients had non–small cell lung cancer (74.5%), 16.7% had small cell lung cancer, and 8.8% had other malignancies. As of the last clinic visit, 35.0% had an ECOG score of 0 whereas 19.3% had a score of 2 or higher. A quarter of these patients had not received treatment for their cancer, whereas 48.2% had received 1 line of therapy and 27.0% had received 2 or more.

Of the patients who died, 45% had received chemotherapy as treatment for their cancer within the past 3 months, about 20% were on immunotherapy, and about 12% received targeted therapy. Significantly fewer patients who recovered from COVID-19 had received recent chemotherapy, about 33%. More than 40% of patients still in the hospital due to COVID-19 infection had received chemotherapy within the last 3 months.

Of the 141 patients in the analysis who had died, death was considered due to COVID-19 infection for 79.4%, due to their cancer diagnosis for 10.6%, and due to both in 8.5%. The cause of death was unknown for 2 patients. More than three-fourths of these patients (78.3%) required hospitalization, 8.3% were admitted to the intensive care unit, and 5.0% required mechanical ventilation. The median length of hospitalization was 10 days.

Some of the risk factors that were found to be associated with mortality were: age of 65 years or more, presence of comorbidities, ECOG performance status of 1 or higher, steroids greater than 10 mg, anticoagulation, and chemotherapy treatment. Alternatively, COVID-19 treatments were not significantly associated with outcome.

"Data collection is ongoing with additional analyses planned to look at patient and provider perception of COVID-19 impact on cancer care," Horn added.


  1. Horn L, Whisenant JG, Torri V, et al; TERAVOLT Consortium Investigators. Thoracic Cancers International COVID-19 Collaboration (TERAVOLT): Impact of type of cancer therapy and COVID therapy on survival. J Clin Oncol. 2020;38(suppl; abstr LBA111). doi:10.1200/JCO.2020.38.15_suppl.LBA111
  2. Garassino MC. TERAVOLT (Thoracic cancERs international coVid 19 cOLlaboraTion): first results of a global collaboration to address the impact of COVID-19 in patients with thoracic malignancies. Presented at: the 2020 AACR Annual Virtual Meeting I; April 27-28, 2020. Session VCTPL09.

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