Chemotherapy Not Associated With Mortality in Cancer Patients With COVID-19

By Lisa Rapaport

June 12, 2020

(Reuters Health) - COVID-19 mortality for cancer patients is driven by age, gender and comorbidities but not by whether they're on cytotoxic chemotherapy or other anticancer treatments, a recent study suggests.

Researchers in the UK examined prospective data on 800 patients with active cancer and diagnosed with COVID-19 infections from March 18, 2020, to April 26, 2020. In this group, 412 (52%) patients had mild COVID infections and 226 (28%) patients died, with a principal cause of death for most (93%) being COVID-19.

Overall, 281 patients had received chemotherapy within four weeks of testing positive for COVID-19. After adjusting for underlying cancer primary site, age, gender, and comorbidities, recent receipt of chemotherapy was not associated with an increased mortality risk.

Other anticancer treatments including immunotherapy, hormonal therapy, radiotherapy, and targeted therapies also weren't associated with increased mortality.

"The results are surprising," said study coauthor Dr. Lennard Lee of the University of Birmingham.

The results should be reassuring to oncologists who have been unsure how to proceed with treatment in the midst of the global COVID-19 pandemic, Dr. Lee said by email.

"There was a general assumption that if oncologists were to continue chemotherapy in the middle of the COVID-19 pandemic, outcomes might be very bad, particularly if cancer patients on chemotherapy got COVID-19," Dr. Lee said. "However, other oncologists felt that if the cancer was not treated, potentially more people might be adversely affected because of problems from their cancer."

Factors that did increase the risk of mortality during the study included advancing age (odds ratio 9.42), being male (OR 1.67), and having hypertension (OR 1.95) or cardiovascular disease (OR 2.32).

For example, 41% of patients who died had hypertension, compared with 27% of patients who survived.

In addition, 21% of patients who died had cardiovascular disease, compared with 11% of those who survived. And, 11% of patients who died had chronic obstructive pulmonary disorder (COPD), compared with 6% of survivors.

In contrast, 33% of patients who died received chemotherapy, compared with 36% of those who survived.

Researchers drew their data from the UK Coronavirus Cancer Monitoring Project, a network of 55 cancer centers with a patient population of nearly 1.5 million people with active cancer. About half of the patients included in the study had metastatic cancer.

One limitation of the study is that the results depended in part on the national COVID-19 testing policy, which is more restrictive than other nations and uses the RT-PCR test that has been associated with a higher false-negative rate than alternatives, the study team writes in The Lancet.

"Additionally, it is hard to sort out whether those sicker patients had chemotherapy or other cancer treatments withheld," said Dr. Bhavana Pothuri, a professor in obstetrics and gynecology at NYU Langone Medical Center and director of gynecologic oncology clinical trials at the Perlmutter Cancer Center in New York City.

"This may have biased the results as well, so it is hard to say definitively that it is safe in all patients," Dr. Pothuri, who wasn't involved in the study, said by email.

However, the study results should still alleviate concerns about continuing critical cancer treatments amid the global COVID-19 pandemic, Dr. Pothuri said.

"Withholding treatment runs the real risk of cancer-related morbidity and mortality, possibly more than the risk of COVID-19 itself," Dr. Pothuri added.

SOURCE: The Lancet, online May 28, 2020.