ASCO 2020: TERAVOLT – Thoracic Cancers International COVID-19 Collaboration: Impact of Cancer Therapy and COVID-19 Therapy on Survival

( COVID-19 Is caused by the infection of coronavirus (SARS-CoV-2). This novel infection began in Wuhan, China, in late 2019 and was later reported in the Western countries in February 2020. The World Health Organization declared a pandemic in early March 2020. In the beginning, increased mortality was reported in people older than 60 or 65 years old and in patients with comorbidities, especially cardiovascular disease, hypertension, and cancer. Reflexively, scientific societies created specific guidelines to reduce the risk of transmission and complications. Patients who had thoracic malignancies were thought to be at higher risk, given their older age, smoking-related comorbidities, and decreased lung function.

The idea behind the TERAVOLT global consortium was formed on March 15th, 2020. From that date until the 8th of May 2020 this consortium has managed to have data cut off on 400 patients with complete data and several important analyses performed. The goals of this consortium are to determine the demographic factors, comorbidities, cancer characteristics, and therapies that place patients with thoracic malignancies, who develop COVID-19, most at risk for hospitalization and death. Other goals include understanding the clinical course of patients with thoracic malignancies infected with COVID-19. The consortium also aims to provide practitioners with real-time data on therapeutic strategies that may impact survival. Additional goals include evaluating the long-term impact on outcomes that are related to the care adjustments and delays in patients with thoracic malignancies. Moreover, the plan is to create a fluid dynamic database that evolves as new information on COVID-19 becomes available.

Inclusion criteria included for this study were stated as any patients with thoracic cancer with a COVID-19 diagnosis defined as follows:

  • Laboratory confirmed (RT-PCR techniques) COVID-19 diagnosis
  • Suspected COVID-19 cases based on clinical factors or based on radiologic evidence which are in accordance with COVID-19 infection manifestations

The analysis of the first 200 patients was presented at the AACR meeting in 2020. The initial presentation demonstrated a median follow-up time of 15 days from COVID-19 diagnosis, and the cohort primarily included European patients (98%), with most being on active therapy (74%). The most common presenting symptoms were fever, dyspnea, and cough. A total of  76% of patients were hospitalized, 9% were admitted to the ICU, and 2.5% of patients required mechanical ventilation.

The univariable analysis showed that patients older than 65 years old, smoking status, chemotherapy alone, all presented an association with an increased risk of being diagnosed with COVID-19. However, the multivariable analysis demonstrated that only age above 65 years old remained statistically significant.  A third of the patients had died, with many of them not being admitted to ICU.

In the currently updated presentation in ASCO 2020 virtual meeting, the cohort included more patients and a much large proportion of patients from the US as well (Figure 1). The cohort had a longer follow-up time with a median of 33 days from the day of COVID-19 diagnosis. The researchers managed to analyze the association between cancer type, stage and COVID-19 diagnosis, and the association between type of anti-cancer therapy and COVID-19 diagnosis. The impact of comorbidities, BMI, and baseline medications on COVID-19 infection was assessed as well, including therapy administered to specifically treat COVID-19 infection.

TERAVOLT patients by country

Figure 1
. Patients by country

Baseline demographic data are shown in Table 1, and the most common comorbidities are shown in Figure 2. Figure 3 depicts cancer therapy types in the last 3 months before COVID-19 diagnosis. Figure 4 is quite interesting and shows the effect of age, comorbidity, and performance status on survival. Lastly, Figure 5 demonstrates the outcome of ongoing and ICU stay. Among 169 recovered patients, 23 did not require hospitalization, and among 118 patients with ongoing infection, 64 patients did not require hospitalization.

Table 1. Baseline demographic data

TERAVOLT baseline demographics

TERAVOLT most frequent comorbidities

Figure 2
. Common comorbidities

TERAVOLT cancer therapy in the last 3 months

Figure 3. Cancer therapy in the last 3 months

TERAVOLT age comorbidity and ps on survival

Figure 4. Effect of age, performance status and comorbidities on survival

TERAVOLT outcome outgoing and icu stay

Figure 5. Outcome ongoing and ICU stay

Multivariable analysis of risk factors associated with death from COVID-19 showed that age above 65 years, performance status 1 vs. 0, and ongoing oncologic therapy vs. no therapy at all, were all associated with increased risk of COVID-19 death. Treatment with steroids prior to COVID-19 infection was trending towards the statistical significance of being associated with increased death from COVID-19.

Dr. Horn concluded her interesting discussion stating that in patients with thoracic malignancies would develop COVID-19, baseline risk factors for mortality include older age, worse performance status, and presence of comorbidities. Interestingly, gender, BMI, smoking status, stage, and type of cancer had no impact on the risk of death from COVID-19. Other interesting data showed that patients on steroids or anticoagulation prior to the diagnosis of COVID-19 were at increase risk of mortality. Additionally, previous administration of chemotherapy (as monotherapy or in combination with immune checkpoint inhibitors), was associated with an increased risk of death, while immunotherapy and TKIs were not. Importantly, the therapy administered to treat COVID-19 was not significantly associated with outcome. To date, data collection is still ongoing with additional analysis planned with a specific goal to look at patient and provider perception of COVID-19 impact on cancer care. 

Presented by: Leora Horn, MD, MSc, Ingram Associate Professor of Cancer Research, Associate Professor of Medicine (Hematology and Oncology), Assistant Director, Educator Development Program, Clinical Director, Thoracic Oncology Program, Vanderbilt University Medical Center, Nashville, Tennessee

Written by: Hanan Goldberg, MD, MSc., Urology Department, SUNY Upstate Medical University, Syracuse, New York, Twitter: @GoldbergHanan at the 2020 ASCO Annual Meeting, Virtual Scientific Program #ASCO20, May 29-31, 2020.

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