Clinical course and outcomes of covid-19 in cancer patients: Early result from 'oncovid-19' study

ABSTRACT

Background: Cancer patients (pts) are considered at higher risk of SARS-CoV-2 infection and more serious COVID-19 illness compared to the general population. We present the early results of the 'onCOVID-19' study exploring clinical course and outcomes of SARS-CoV-2 infection in cancer pts. Methods: In this observational study, we collected clinical data of pts referred to our institution with histologically confirmed diagnosis of solid cancer and COVID-19 from Feb 1 to May 20,2020. COVID-19 diagnosis was laboratory or radiologically confirmed or clinically suspected for suggestive symptoms, including fever (>37,5°C) and/or respiratory tract symptoms, without any other causes. Univariate and multivariate analyses were performed to explore the risk factors associated with severe events defined as hospitalization, admission to an intensive care unit, mechanical ventilation or death. Results: Of the 64 pts enrolled, 35 referring to our Oncology Unit were analysed;the remaining 29, treated for cancer in other institutions, will be included in the analysis after data completion. Pts characteristics male/female (63/37%), current or former/never smokers (76/24%);stage IV/III (83/17%);median age 63 (47-86) years. Lung was the most frequent site of primary tumor (43%) or metastases (37%). Out 26 (74%) pts on active anti-tumor treatment, 6 (23%) received immune checkpoint inhibitors (ICI). Most common symptoms were fever (40%), shortness of breath (34%) and cough (23%);lymphopenia (<1000/mm3) was found in 5/15 (33%) tested pts. The diagnosis of COVID-19 was only clinical suspected in 2 (6%) cases and confirmed by RT-PCR or imaging (ground glass opacity and/or patchy consolidation) in 11 (31%) and 31 (88%) pts, respectively. An anti-microbial (antibiotics, antiretroviral drugs, plasma therapy) treatment was administrated in 19 (54%) pts;oxygen supplementation was required in 11 (31%) pts. Eleven (31%) pts had severe events, death occurred in 7 (20%) cases. Higher risk for developing severe events was associated with active treatment (RR 4.03, 95%CI 1.8-8.9,p=0.007) and lymphopenia (RR 4.0, 95%CI 1.1-14, p=0.007). Conclusions: Early results of our ongoing study confirmed the vulnerability of cancer pts to COVID-19. Although the small sample size, treatment with ICI and lymphopenia seem to be risk factors for death and severe events. Waiting for final results, screening cancer pts for infection should be advisable before starting immunotherapy or in case of lymphopenia.