Recent chemotherapy may not worsen COVID-19 outcomes
medwireNews: Receipt of cytotoxic chemotherapy in the 3 months before testing positive for SARS-CoV-2 infection is not associated with an increased risk for severe COVID-19 symptoms, US research suggests.
Melissa Pessin and team, from Memorial Sloan Kettering Cancer Center in New York, report on a cohort of 309 patients from their institution, and note that the results were similar regardless of whether patients received chemotherapy 14, 35, or 90 days before the SARS-CoV-2 test.
“These findings contrast with those of a smaller study from China that suggested worse outcomes with chemotherapy despite a similar end point of severe COVID-19 but align with larger studies that found no effect of chemotherapy on COVID-19–associated mortality in patients with cancer in the United States, Spain, Canada, and the United Kingdom,” they write in the Journal of Clinical Oncology.
Of the 309 cancer patients with a laboratory-confirmed diagnosis of SARS-CoV-2 between 8 and 31 March 2020, 33% had received cytotoxic chemotherapy in the 35 days prior to the diagnosis.
Overall, more than a third (38.8%) of the cohort developed the primary composite endpoint of severe or critical COVID-19, defined as the development of one or more of the following events:
- documented hypoxemia (oxygen saturation by pulse oximetry ≤93%);
- tachypnea (respiratory rate ≥30 breaths/min);
- respiratory failure (ratio of arterial partial pressure of oxygen to fraction of inspired oxygen <300);
- intensive care admission for intubation; or
- all-cause death.
However, there was no significant association between the risk for severe or critical COVID-19 and receipt of chemotherapy within 35 days of the COVID-19 diagnosis. And this was also the case when the researchers considered treatment windows within 14 and 90 days of the diagnosis.
They highlight, however, that the model did not include race or socioeconomic status, and comment that “[a]dditional investigation with a larger sample size will be required to determine whether chemotherapy differentially affects patients of diverse races who contract SARS-CoV-2.”
Pessin and colleagues identified other factors that were significant predictors of worse COVID-19 outcomes after multivariable adjustment, including lymphopenia at COVID-19 diagnosis (hazard ratio [HR]=1.92), a diagnosis of thoracic (HR=2.04) or hematologic cancer (HR=2.10), and neutropenia prior to the COVID-19 test (HR=4.01).
“Our study will help to guide providers in making decisions about cancer-directed therapy in patients with cancer and COVID-19,” and “may also influence management of patients with lung cancer, hematologic malignancies, or leukopenia at the time of COVID-19 diagnosis,” comment the study authors.
And they conclude: “As the landscape of COVID-19 research evolves, further prospective, randomized investigation is warranted to explore how SARS-CoV-2 interacts with specific cancer subtypes and to further characterize the risk of adverse events in patients with COVID-19 undergoing different cancer therapies.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
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