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Lung Cancer Patients and COVID-19: What We Are Learning

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Published on June 25, 2020

Lung Cancer Patients and COVID-19: What We Are Learning

Dr. Leora Horn, from Vanderbilt-Ingram Cancer Center, shares key findings from the global consortium TERAVOLT, an ongoing study tracking outcomes of thoracic cancer patients infected with coronavirus.

The international patient registry seeks to provide a framework for how to care for lung cancer patients during the pandemic by gathering information on demographics, oncological history, comorbidities, COVID-19 diagnosis and clinical outcomes. Watch to hear what the early data suggests.

Transcript | Lung Cancer Patients and COVID-19: What We Are Learning

Dr. Horn:
Hi I'm Leora Horn. I am the Director of the Thoracic Oncology Program here at Vanderbilt University Medical Center in Nashville, Tennessee. I'm an Ingram Associate Professor of Cancer Research and an Associate Professor of Medicine in the Department of Hematology Oncology. And I have an interest in treatment of patients with thoracic malignancies. And COVID-19, which we know started in Wuhan, China in late 2019 was first reported in the western countries in February of this year and the WHO declared a pandemic in March of this year. We started a global consortium called TERAVOLT in the middle of April. This consortium was started after we got an email from Dr. Marina Garassino, she's a phenomenal thoracic oncologist in Milan, Italy. And she sent an email out to 50 of her colleagues talking about her concerns about COVID-19 and the SARS-CoV-2 virus and how it was affecting our patients with thoracic malignancies, not only the mortality that she was seeing in her lung cancer patients, but also concerns she had about the delays in care.

Dr. Garassino actually presented the first analysis of the first 200 patients at AACR this year. And it was published in Lancet Oncology last week. And at ASCO this year, we presented an updated analysis on the first 400 patients that were sequentially entered into the database. Our consortium goals are fairly clear. We want to understand the demographic factors, cancer characteristics, patient comorbidities that put patients with thoracic malignancies at risk for COVID-19 and for mortality from COVID-19. We also want to give our colleagues some real time data so that they can act on their patients if they are infected with the virus in terms of treatment strategies to help mitigate morbidity and mortality. And we also want to see, what are the long-term impacts on cancer outcomes? Because many of our patients had delays in care because of COVID-19.

We found that the median age of our patients was late sixties, early seventies, which the median age for lung cancer diagnosis is 72. The majority of our patients were either current or former smokers. Most of them had a good performance status and that they were active, able to do light housework, up and about during the day. Most of our patients had a normal body mass index. And this is important because there is some data in the literature suggesting body mass index might be associated with mortality from COVID-19. 75% of our patients had non-small cell lung cancer. The majority of patients had stage four disease and anywhere from 88 to 90% of patients had a confirmed RT-PCR test. We broke the patients down into three groups. Those patients who were recovered, which is about 40% of our patient population, those patients who had died and those patients with an ongoing infection.

What we found was quite startling and that being that 35.5% of patients with thoracic malignancies who had COVID-19 had died as a result. This is significantly higher than what we see in the general patient population. And it's also higher than what was reported in CCC-19, which is a North America based consortium looking at impact of COVID-19 in all cancer types. In that particular analysis, they only have about a 100 lung cancer patients. And the mortality rate was only around 13%. We also looked at what were the co-morbidities? Can we specifically put one being associated with mortality from COVID-19? Our patients had hypertension, COPD, diabetes, vascular disease, all that had been associated with potential risk of death from COVID-19 in the general patient population. We couldn't tie one specific co-morbidity to death from COVID-19, but we did note that the presence of any co-morbidity puts patients at risk for death from COVID-19.

We also found that patients who were over 65 years old who had an ECOG performance status of one or more. ECOG performance status of zero means that you're up and about, no limitations. One means you're able to do some light housework, but maybe you do have some limitations in your daily function.

We also found that patients who had had chemotherapy either alone or in conjunction with immunotherapy in the last three months were higher risk of mortality from COVID-19. We also found that the use of steroids over 10 milligrams a day, prednisone, or the use of anticoagulation put patients at risk for COVID-19. Now CCC19 found that patients who were treated with hydroxychloroquine azithromycin were at increased risk of mortality from COVID-19, while we found that none of the treatments that were given to treat COVID-19 put patients at risk for mortality. We also found that none of the therapies such as hydroxychloroquine or antibiotics or antifungals, steroids actually appeared to help our patients. They didn't increase the chance of recovery unfortunately. What we also found in the lung cancer population, which is a little bit different from what they found from CCC19, is that around 78% of our patients were hospitalized, which is a lot. 80% of our patients who died, died as a result of COVID-19 and only 11% of patients who died could actually have their deaths during COVID-19 attributed to their cancer.

I think it's also important to notice, and it really struck home to me that 75% of patients either had no therapy or were just on first line therapy. These were clearly patients who were at the start of their cancer journey, potentially had good outcomes if they were able to survive COVID-19. But unfortunately they died as a result of the infection. We found that the median length of hospitalization was around 10 days for patients who were admitted to hospital. And I think we'll get a better idea as we get more of this data. Now, the consortium continues - as I mentioned, we presented data on about 400 patients from ASCO. We're now close to 700 patients and our goal is to continue to accrue during the pandemic. We want to provide practitioners with sort of a framework of how to think about and how we should treat our thoracic patients during COVID-19.

I think it's an important message that you shouldn't stop care. Patients still need to get care. If chemotherapy is the best therapy for our patients, we need to allow them to continue to get chemotherapy. What we do need to figure out is how do we give the drug safely? How do we minimize our patients' interaction with the healthcare environment? How do we keep them safe in the hospitals? What's good news for our thoracic cancer patients is that the use of tyrosine kinase inhibitors, because a lot of our patients are on oral therapies and immunotherapy did not appear to increase mortality. But again, even those patients, I think we need to figure out how do we minimize their interaction with the healthcare environment? How do we use telehealth? How do we use remote CT scan monitoring? All those sort of things to keep our patients safe with the pandemic.

Our next steps are to look at how the delay in cancer care impacts on cancer survival. What happens if a patient doesn't get their therapy for two months because they're afraid to come into the hospital? Are we shortening their lung cancer survival? We're also, there are folks who are interested in looking at sort of stage migration. Are we going to see more patients coming in with advanced stage disease because patients are not going in for their screening CT scans? There was data from a European study that looked at lung cancer screening and found that annual scans was better than doing scans every other year. And importantly, we have a patient survey that's going to be launching through our website,, looking at the patient perspective. What are their fears? What are their concerns for our patients with thoracic malignancy during this pandemic?

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