Risk factors for Coronavirus Disease 2019 (COVID-19) severity and mortality among solid cancer patients and impact of the disease on anticancer treatment: A French nationwide cohort study (GCO-002 CACOVID-19)

Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. In this large nationwide retro-prospectiv...

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Published in:	European journal of cancer (1990) Vol. 141; pp. 62 - 81
Main Authors:	Turpin, Anthony, Thariat, Juliette, Debieuvre, Didier, Wislez, Marie, Mansi, Laura, Colomba, Emeline, Idbaih, Ahmed, Zalcman, Gérard, Aparicio, Thomas, Goasdoue, Henri, Khamari, Marwa, Regimbeau, Jean Marc, Hautefeuille, Vincent, Dehais, Mélanie, Talfi, Safia, Benrezzak, Nasro, Vignes, Emanuelle, Hocine, Fayçal, Almotlak, Hamadi, Sun, Xu-Shan, Wasselin, Julie, Fadin, Aurélie, Ramdani, Mohamed, Garbay, Delphine, Trouba, Cécile, Babin, Emmanuel, Leon, Vincent, Desauw, Christophe, Peres, Christina, Mille, Dominique, Combe, Pierre, Jonveaux, Eric, Kaluzinski, Laure, Riviere, Frédéric, Moreau, Lionel, Ahle, Guido, Degriffolet, Dominique, Sebbagh, Virginie, Lozach-Brugirard, Marion, Loutski, Sandrine, Cattelain, Sophie, Darloy, Franck, Jolimoy Boilleau, Geneviève, Maissiat, Cyrielle, Charifi-Alaoui, Ikram, Valenza, Bruno, Paitel, Jean-François, Kreitmann, Thomas, Boucheret, Paul, Tchikladze, Christine, Herve, Camille, Bieber, Elsa, Rosso, Maud, Pham-Becker, Alice, Louafi, Samy, Egreteau, Joëlle, Prunier-Bossion, Florence, Ray Coquard, Isabelle, Norguet Monnereau, Emmanuelle, Boucard, Céline, Locher, Christophe, Auby, Dominique, Petran, Daniela, Rousseau, Dominique, Castanie, Hélène, Vannetzel, Jean-Michel, Roger, Antoine, Stroksztejn, Magda, Simon Anne, Sophie, Vo, Maryline, Brouk, Zohra, Colle, Raphaël, Bennamoun, Mostefa, Raymond, Eric, Palmieri, Lola Jade, Goujon, Gaël, Gazeau, Benoit, Belkhir, Kahina, Spano, Jean-Philippe, Gibiat, Stéphanie, Suc, Etienne, Dewolf, Maxime, Dumazet, Antoine, Marchand-Crety, Charles, Fosse, Patricia, Ferrand, François-Régis, Ligeza Poisson, Catherine, Williet, Nicolas, Ramirez, Carole, Perruisseau-Carrier, Joffrey, Barret, Flavie, Barlet, Agnès, Vernisse, Mylène, Lafond, Sophie, Panouille, Quentin, Cambula, Linda, GermaIn, Adeline
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-12-2020 Elsevier Science Ltd Elsevier
Subjects:	Aged Anticancer properties Antineoplastic Agents - adverse effects Antineoplastic Agents - therapeutic use Cancer Cancer therapies Chemotherapy Cohort analysis Cohort Studies Coronaviruses Corticoids Corticosteroids COVID-19 COVID-19 - mortality Cytotoxicity Death Diagnosis Female France - epidemiology Health risks Health services Humans Immunotherapy Intensive care unit Life Sciences Male Mechanical ventilation Medical treatment Mortality Multivariate analysis Neoplasms - mortality Neoplasms - therapy Neoplasms - virology Original Research Pandemics Polymerase chain reaction Prospective Studies Radiotherapy Respiratory diseases Retrospective Studies Risk analysis Risk Factors RNA-directed DNA polymerase SARS-CoV-2 - isolation & purification Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Sex ratio Solid tumors Subgroups Thorax Tumors Ventilation Viral diseases France COVID-19 Chemotherapy Mortality Immunotherapy Death Radiotherapy Mechanical ventilation Intensive care unit Cancer
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Summary:	Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and 11th June 2020. The primary end-point was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary end-points. From April 4 to 11th June 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18–2.52), The Eastern Cooperative Oncology Group Performance Scale (ECOG PS) ≥ 2 (OR 3.23, 95%CI: 2.27–4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01–1.16) and admission to ICU (OR 3.62, 95%CI 2.14–6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except for cytotoxic chemotherapy in the subgroup of patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR), which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00–2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment (such as chemotherapy, targeted or immune therapy) interrupted or stopped following diagnosis of COVID-19. Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis. •A total of 1289 patients with solid tumours and COVID-19 were analysed.•Mortality and COVID-19 severity were mainly driven by patients′ general characteristics.•Overall, we found no deleterious effects of recent anticancer treatments on mortality.•Systemic anticancer treatment was interrupted or stopped in 39% of patients.
Bibliography:	Equally contributed to the work. Please see the Appendix for a list of the GCO-002 CACOVID-19 collaborators/investigators.
ISSN:	0959-8049 1879-0852
DOI:	10.1016/j.ejca.2020.09.035