Mortality of 1,636 COVID-19 cancer patients (pts) and associated prognostic factors

ABSTRACT

Background: We assessed mortality risk by COVID-19 (C19) infection among treated cancer patients (pts) and the impact of anti-cancer treatment (tx) on mortality. Methods: Optum de-identified Electronic Health Record dataset (2021-01-07 release) were used to find cancer pts with a C19 positive (ICD-9/10-CM codes U071/U072 or positive test result) or negative (negative test and no positive test at any time after the first negative result) status on the first test/diagnosis date (ie the “index date”). Pts with <1 year database history, with no tx 0-90 days before index, <18 years old, with implausible death dates, and with index dates outside of 02/2020 - 11/2020 were excluded. C19 positive and negative pts were exact-matched on cancer type, then 11 nearest-neighbor matched on propensity scores (variables in table). Missing values were imputed (n = 5), and outcomes were evaluated by multivariable logistic regression, including interaction terms between tx and C19 positivity. Results: We identified 21,060 pts, of whom 1,636 (7.8%) were positive for C19 and 19,424 (92.2%) negative. Among 1,636 matched pairs of positive/negative C19 pts, the odds ratio (OR) of 30-day mortality comparing C19 positive vs negative patients was 2.14 (95% CI 0.71 – 6.52). Among the strongest predictors of 30-day mortality were age 75+ (OR = 5.42, 95% CI 2.21 – 13.28), inpatient C19 testing/diagnosis (OR = 4.78, 95% CI 3.04, 7.53), CCI of 3+ (OR = 2.24, 95% CI 1.30 – 3.89), and metastatic disease (OR = 1.80, 95% CI 1.21 – 2.68). Anti-cancer therapies do not appear to modulate risk of death due to C19. Beyond 30-day mortality, matched mortality rate ratios (MRRs) suggested increased risk for C19 positive patients (MRR = 1.85, 95% CI 1.26 – 2.44). [Formula presented] Conclusions: C19 showed a trend towards increased 30-day mortality risk (not statistically significant), and increased overall mortality risk. Specific tx did not appear to modulate 30-day mortality due to C19. Legal entity responsible for the study Genentech, Inc. Funding: Roche/Genentech. Disclosure P.A. Ascierto Financial Interests, Personal, Advisory Board Bristol Myers Squibb, Roche-Genentech, Merck Sharp & Dohme, Novartis, Array, Merck Serono, Pierre-Fabre, Incyte, Medimmune, AstraZeneca, Syndax, Sun Pharma, Sanofi, Idera, Ultimovacs, Sandoz, Immunocore, 4SC, Alkermes, Italfarmaco, Nektar, Boehringer Ingelheim;Financial Interests, Personal, Research Grant Bristol Myers Squibb, Roche-Genentech, Array, Sanofi;Financial Interests, Personal, Other MSD;Non-Financial Interests, Personal, Advisory Board TAKIS. M.H. Secrest Financial Interests, Personal, Full or part-time Employment Roche/Genentech;Financial Interests, Personal, Stocks/Shares Roche. P. Lambert Financial Interests, Personal, Full or part-time Employment Genentech/Roche;Financial Interests, Personal, Stocks/Shares Roche. K. Sarsour Financial Interests, Personal, Full or part-time Employment Roche/Genentech;Financial Interests, Personal, Stocks/Shares Roche. A. Tan Financial Interests, Personal, Full or part-time Employment Roche/Genentech;Financial Interests, Personal, Stocks/Shares Roche. R. Walls Financial Interests, Personal, Full or part-time Employment Hoffmann-La Roche;Financial Interests, Personal, Stocks/Shares Hoffmann-La Roche. J. Reddy Financial Interests, Personal, Full or part-time Employment Roche/Genentech;Financial Interests, Personal, Stocks/Shares Roche. A. Seetasith Financial Interests, Personal, Full or part-time Employment Genentech, Inc.;Financial Interests, Personal, Stocks/Shares Roche. D. Shenison Financial Interests, Personal, Full or part-time Employment Roche/Genentech;Financial Interests, Personal, Stocks/Shares Roche, Cigna. I. Ngwa Financial Interests, Personal, Full or part-time Employment F. Hoffmann - La Roche Ltd;Financial Interests, Personal, Stocks/Shares F. Hoffmann - La Roche Ltd. C. Yun Financial Interests, Personal, Full or part-time Employment Genentech, Inc.;Financial Interests, Personal, Stocks/Shares Roche. Q. Zhang Financial Interests, Personal, Full or part-time Employment Roche/Genentech;Financial Interests, Personal, Stocks/Shares Roche, Regeneron, BMS, AbbVie, AC Immune.