Brief Report: Impact of anti-cancer treatments on outcomes of COVID-19 in patients with thoracic cancers: a CCC19 registry analysis

Introduction Patients with thoracic cancers have one of the highest mortality rates among patients with cancer and COVID-19. Data evaluating the impact of recent anti-cancer therapies on COVID-19 outcomes in patients with thoracic cancers are confined to heterogenous studies with limited follow-up data. We leveraged data from the COVID-19 and Cancer Consortium (CCC19) (NCT04354701) to analyze the impact of recent anti-cancer therapies on the clinical outcomes of COVID-19 in patients with thoracic cancers. Methods The CCC19 registry was queried for adult patients with thoracic cancer and laboratory-confirmed SARS-CoV-2 infection. Patients with low-quality data were excluded. The primary outcome was six-level ordinal scale of COVID-19 severity. Secondary outcome was 30-day all-cause mortality. Patients were stratified by the receipt of any anti-cancer treatment within 3 months prior to COVID-19 into chemotherapy alone; chemotherapy with immunotherapy; chemotherapy and radiation; chemotherapy and targeted therapy; immunotherapy alone; targeted therapy alone, other combinations, and locoregional therapy only. Multivariable logistic regression was used to test the association of these treatments with the outcomes after adjustment for key clinical and demographic covariates. Results From January 2020 to December 2021, 927 patients with thoracic cancer met the inclusion criteria. Median age was 70 years (Interquartile range [IQR] (62-77 years)), 54% were female, 79% were former or current tobacco users, and 49% had pulmonary comorbidities. At median follow up time of 59 days (IQR 27-180 days), 52% (N=482) of patients received at least one anti-cancer therapy <3 months prior to COVID-19 diagnosis. Immunotherapy alone was the most prevalent treatment exposure (19%; N=93). 30-day all-cause mortality was 22% and overall mortality was 30%. Patients who received locoregional therapy and cytotoxic chemotherapy alone had higher 30-day all-cause mortality (37%, and 27% respectively). On the other hand, patients who received immunotherapy or targeted therapy had numerically lower 30-day all-cause mortality (15% and 17% respectively). On multivariable analysis, only recent chemotherapy use was significantly associated with COVID-19 severity (aOR 2.54; 95% CI 1.41-4.56). None of the other treatment modalities were significantly associated with COVID-19 severity or 30-day all-cause mortality. Among the patients who used baseline steroids of 10 mg or more of prednisone equivalent (12%), there was no significant interaction for COVID-19 severity and 30-day all-cause mortality. Conclusion We report a large study evaluating the clinical outcomes of COVID-19 in the context of recent anti-cancer treatments for thoracic cancers. Only recent chemotherapy use was associated with the primary outcome of COVID-19 severity. The study provides reassuring data that patients receiving anti-cancer treatments even in the context of palliative treatment appear not to have a significantly higher risk of mortality.