Defining COVID-19 outcomes in thoracic cancer patients: TERAVOLT (Thoracic cancERs international coVid 19 cOLlaboraTion)

ABSTRACT

Background: Patients with thoracic malignancies may have increased risk for COVID-19 mortality. This risk may be attributable to age, comorbidities, smoking history, pulmonary disease burden and cancer-directed therapies. Methods: TERAVOLT is a global consortium examining outcomes and assessing risk factors associated with mortality of patients with thoracic malignancies and COVID-19 infection. Results: As of July 15, 2020, 1012 patients from 20 countries have been entered;median age was 68 with 58 % male, 80% current/former smokers, most common comorbidities of HTN (49%) & COPD (26%);82% NSCLC, 68 % patients with stage IV disease at COVID diagnosis, 65% on treatment (38% chemotherapy, 26% immune checkpoint inhibitor (ICI), 16 % targeted tyrosine kinase inhibitor (TKI). Of these, 72% were hospitalized;56% of patients developed complications, most frequently pneumonia (40%) and 47% who did not have prior oxygen therapy required it. 32% of patients died during their COVID-19 infection. Only 33 % of patients continued their oncology treatment after infection. Patients presenting with pneumonia (OR 2.7 2-3.5), consolidation (OR 2 CI 1,5-2,8), bilateral lung abnormalities (OR 2,8 CI 2-3,9) and pleural effusion (OR 2,7 CI 1,8-4) were at increased risk of mortality. In multivariate analysis age ≥ 65 (OR 1,53 CI 1,11-2,1), active smoking (OR 2 CI 1,3-3), higher stage of cancer (OR 1,9 CI 1,3-2,7), ECOG PS ≥2 (OR 3,7 CI 2,7-5), steroids prior to COVID diagnosis (OR 1,8 CI 1,2-2,7), were associated with increased risk of death, while chemotherapy and TKI therapy use were not and interestingly patients on immunotherapy appeared to be at decreased risk for mortality (OR 0,6 CI 0,5-0,97). Conclusions: Facing this ongoing global pandemic, TERAVOLT is the largest thoracic malignancy database confirming the high risk for COVID-19 mortality in this specific patient group. Physicians need to evaluate the risk of mortality from COVID-19 based on age, smoking status, stage of cancer, performance status, need for steroids and specific therapy in order to determine the appropriateness for cancer therapy and tailor patient care taking into account patients’ wishes and status of pandemic in the country. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure J. Baena Espinar Advisory/Consultancy AstraZeneca;Honoraria (self), Travel/Accommodation/Expenses Angelini. F.R. Hirsch Advisory/Consultancy AstraZeneca;Advisory/Consultancy BMS;Advisory/Consultancy Merck;Advisory/Consultancy Daiichi;Advisory/Consultancy Genentech/Roche;Advisory/Consultancy Lilly/Loxo;Advisory/Consultancy Boehringer-Ingelheim. M. Tiseo Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution) AstraZeneca;Advisory/Consultancy, Research grant/Funding (institution) Boehringer Ingelheim;Advisory/Consultancy Novartis;Advisory/Consultancy MSD;Advisory/Consultancy BMS;Advisory/Consultancy Takeda. E. Felip Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau AbbVie;Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau AstraZeneca;Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Blue Print Medicines;Advisory/Consultancy, Advisory role or speaker's bureau Boehringer Ingelheim;Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Bristol-Myers Squibb;Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau GSK;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Eli Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Guardant Health;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Janssen;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Medscape;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Merck KGaA;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Spea er's bureau Merck Sharp and Dohme;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Novartis;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Pfizer;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau prIME Oncology;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Roche;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Samsung;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Springer;Advisory/Consultancy, Speaker Bureau/Expert testimony, Advisory role or Speaker's bureau Takeda;Advisory/Consultancy, Advisory role or Speaker's bureau Touchime;Research grant/Funding (self), Research Funding: Fundacion Merck Salud;Research grant/Funding (institution), Research Funding: Grant for Oncology Innovation;Full/Part-time employment, Board (Independent Member Grifols Boards. H.A. Wakelee Research grant/Funding (institution), Clinical Research grant Gilead;Honoraria (self), Advisory/ Consultancy, advisor or consultant honoraria AstraZeneca;Advisory/Consultancy, Research grant/Funding (institution), advisor or consultant, research Xcovery;Advisory/Consultancy, advisor or consultant Jassen;Advisory/Consultancy, advisor or consultant Daiichi Sankyo, INC;Advisory/Consultancy, advisor or consultant Helsinn;Advisory/Consultancy, advisor or consultant Mirati;Advisory/Consultancy, advisor or consultant (not Takeda;Advisory/Consultancy, advisor or consultant (not Cellworks;Advisory/Consultancy, Research grant/Funding (institution), advisor or consultant (not Genentech/Roche;Advisory/Consultancy, Research grant/Funding (institution), advisor or consultant (not Merck;Travel/Accommodation/Expenses, CME presentation (travel funding) Clinical care options oncology, LLC;Travel/Accommodation/Expenses, CME presentation (travel funding) Fishawack facilitate LTD;Travel/Accommodation/Expenses, CME presentation (travel funding) Medscape;Travel/Accommodation/Expenses, CME presentation (travel funding) Onclive/intellisphere LLC;Travel/Accommodation/Expenses, CME presentation (travel funding) Philips Gillmore Oncology 2018;Travel/Accommodation/Expenses, CME presentation (travel funding) Physician education resource, LLC/MJH;Travel/Accommodation/Expenses, CME presentation (travel funding) Potomac center for medical education;Travel/Accommodation/Expenses, CME presentation (travel funding) Prime Oncology LLC (2018);Travel/Accommodation/Expenses, CME presentation (travel funding) Primo (2018);Travel/Accommodation/Expenses, CME presentation (travel funding) Research to practice;Travel/Accommodation/Expenses, CME presentation (travel funding) UpToDate;Travel/Accommodation/Expenses, CME presentation (travel funding) WebMdHealth;Honoraria (self), Research grant/Funding (institution), honoraria, research funding to Novartis;Travel/Accommodation/Expenses, International professional society RGCON- Rajiv gand conference;Travel/Accommodation/Expenses, International professional society JLCS - japanese lung cancer society;Travel/Accommodation/Expenses, International professional society KSMO - korean society of medical oncology;Full/Part-time employment, professor of medicine Stanford university;Travel/Accommodation/Expenses, Scientific advisory committe - travel ITMIG;Research grant/Funding (institution), research funding to institution ACEA biosciences. M.C. Garassino Honoraria (self) Boehringer Ingelheim;Honoraria (self), Local PI, Enrollment in clinical Trials in Otsuka Pharma;Honoraria (self), Research grant/Funding (institution), PI, Enrollment and Steering AstraZeneca;Honoraria (self), Research grant/Funding (institution), PI, Enrollment in clinical Trials in Novartis;Honoraria (self), Research grant/Funding (institution), PI, Enrollment in clinical Trials in BMS;Honoraria (self), Research grant/Funding (institution), PI, Enrollment in clinic l Trials in Roche;Honoraria (self), Research grant/Funding (institution), PI, MISP in Thimic malignancies Pfizer;Honoraria (self), Research grant/Funding (institution), PI, Enrollment in clinical Trials in Celgene;Research grant/Funding (institution) Incyte;Research grant/Funding (institution) Inivata;Research grant/Funding (self) Takeda;Honoraria (self), PI, Enrollment in clinical Trials Thimic Tiziana Sciences;Honoraria (self), PI, Enrollment in clinical Trials in Clovis;Honoraria (self), PI, Enrollment in clinical Trials in Merck Serono;Honoraria (self), Research grant/Funding (self), PI, Enrollment in clinical Trials in Bayer;Honoraria (self), Research grant/Funding (institution), PI, Enrollment in clinical Trials in MSD;Honoraria (self), Local PI, Enrollment and Steering GlaxoSmithKline S.p.A.;Research grant/Funding (institution) Sanofi-Aventis;Honoraria (self), PI, Enrollment in clinical Trials Spectrum Pharmaceutcials;Honoraria (self), PI, Enrollment in clinical Trials Blueprint Medicine;Research grant/Funding (institution) Seattle Genetics;Research grant/Funding (institution) Daiichi Sankyo;Honoraria (self), PI, MISP in Thimic malignancies Eli Lilly. S. Peters Honoraria (self), Advisory/Consultancy, Advisory board + honorarium AbbVie;Honoraria (self), Advisory/Consultancy, Advisory board + honorarium Amgen;Honoraria (self), Advisory/Consultancy, Advisory board + honorarium AstraZeneca;Honoraria (self), Advisory/Consultancy, Advisory board + honorarium Bayer;Honoraria (self), Advisory/Consultancy, Advisory board + honorarium Biocartis;Honoraria (self), Advisory/Consultancy, Advisory board + honorarium Boehringer-Ingelheim;Honoraria (self), Advisory/Consultancy, Advisory board + honorarium Bistrol-Myers Squibb;Honoraria (self), Advisory/Consultancy, Advisory board + honorariumClovis;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Daiichi Sankyo;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Debiopharm;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Eli Lilly;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium F. Hoffmann-La Roche;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Foundation Medicine;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Illumina;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Janssen;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Merck Sharp and Dohme;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Merck Serono;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Merrimack;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Novartis;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Pharma Mar;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Pfizer;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Regeneron;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Sanofi;Honoraria (self), Advisory/Consultancy, Advisory Board + honorarium Seattle Genetics and Takeda;Honoraria (self), Speaker Bureau/Expert testimony, Talk + honorarium AstraZeneca;Honoraria (self), Speaker Bureau/Expert testimony, Talk + honorarium Boehringer-Ingelheim;Honoraria (self), Speaker Bureau/Expert testimony, Talk + honorarium Bristol-Myers Squibb;Honoraria (self), Speaker Bureau/Expert testimony, Talk + honorarium Eli Lilly;Honoraria (self), Speaker Bureau/Expert testimony, Talk + honorarium F. Hoffmann-La Roche;Honoraria (self), Speaker Bureau/Expert testimony, Talk + honorarium Merck Sharp and Dohme. L. Horn Advisory/Consultancy, Consulting AstraZeneca;Advisory/Consultancy, Consulting Genentech-Roche;Advisory/Consultancy, Consulting Incyte;Advisory/Consultancy, Consulting Merck;Advisory/Consultancy, Consulting Pfizer;Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses, Consulting and travel to meeting Xcovery;dvisory/Consultancy, Consulting EMD Serono;Advisory/Consultancy, Consulting Tesaro;Advisory/Consultancy, Consulting AbbVie;Research grant/Funding (self) Boehringer Ingelheim;Research grant/Funding (self), Travel/Accommodation/Expenses, Honorarium BMS;Honoraria (self), Honorarium Medscape;Honoraria (self), Honorarium PER;Honoraria (self), Honorarium Research to Practice;Honoraria (self), Honorarium OncLive;Advisory/Consultancy, Consulting Amgen;Advisory/Consultancy, Consulting Bayer. All other authors have declared no conflicts of interest.