Progressive cancer or treatment of COVID-19 infection with hydroxychloroquine and azithromycin were associated with an increased risk of death among patients with a history of cancer, according to results from the COVID-19 and Cancer Consortium (CCC19) registry presented at the ASCO20 Virtual Scientific Program.1

The analysis was simultaneously published in the Lancet.2

“[These are] early and evolving data, and more time and analysis will be needed to confirm and expand on these findings,” Jeremy L. Warner, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, said in a press release.3

The CCC19 registry (ClinicalTrials.gov Identifier: NCT04354701) was founded on March 15, 2020, and accepts reports in real time or after COVID-19 illness. Enrollment to the registry is open to site-level participation in the United States and Canada, and anonymized reports globally. Participating sites are required to identify all cases of COVID-19, not just those requiring hospitalization, Dr Warner said.


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The current analysis includes 928 patients from 104 institutions in the United States, Canada, and Spain with active or prior cancer who also contracted COVID-19 between March 17 and April 16, 2020.2

At the time of the analysis, the median age of patients was 66 years (range, 18-90 years), with 30% of patients aged at least 75 years; 50% of the patients were male. Currently, approximately 43% of patients in the registry have active cancer and 39% of patients were receiving anticancer treatment. Solid malignancy was present in 82% of patients, with the most common cancer types including breast (21%) and prostate (16%). Asymptomatic COVID-19 was present in 4% of patients.

The analysis found that 13% of patients died during a median follow-up of 21 days. Hospitalization was required for 50% of patients, of whom, 23% died. The composite endpoint occurred in 26% of patients, ICU admission occurred for 14% of patients, and 12% required mechanical ventilation.

Progressive cancer was significantly associated with mortality within 30 days of a COVID-19 diagnosis compared with patients whose disease was in remission (odds ratio [OR], 5.20; 95% CI, 2.77-9.77). The combination of hydroxychloroquine and azithromycin was also associated with a significantly higher risk of death within 30 days compared with patients who did not take the drugs (OR, 2.93; 95% CI, 1.79-4.79); however, the authors acknowledged that confounding by indication could not be excluded.2 Hydroxychloroquine or azithromycin alone were not associated with increased risk of death.

Approximately 20% of patients received hydroxychloroquine azithromycin and an additional 10% received hydroxychloroquine alone, Dr Warner said during the press briefing. Only 2 patients received hydroxychloroquine as part of a clinical trial, and about 10% were taking the drug at the time of their COVID-19 presentation.

Age  of at least 75 years, male sex, former smoking, and Eastern Cooperative Oncology Group performance status of 2 or higher were also independently associated with an increased risk of 30-day mortality. There was no association between cancer type, number of comorbidities, type of anticancer therapy, recent surgery, race/ethnicity, or obesity.

“The registry has now accrued 2143 cases and another analysis of this larger cohort is under way,” Dr Warner said in conclusion.

References

  1. Warner JL, Rubinstein SM, Grivas P, et al. Clinical impact of COVID-19 on patients with cancer: data from the COVID-19 and Cancer Consortium (CCC19). Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl):abstr LBA110.  
  2. Kuderer NM, Choueiri TK, Shah DP, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study [published online May 28, 2020]. Lancet. doi: 10.1016/S0140-6736(20)31187-9
  3. American Society of Clinical Oncology. Early data show cancer progression associated with increased risk of death in patients with COVID-19 [press release]. Published May 28, 2020. Accessed May 31, 2020.

This article originally appeared on Cancer Therapy Advisor