Clinical course and outcome of COVID-19 in cancer patients: Early results from the “onCOVID-19” study

ABSTRACT

Background: Cancer patients 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 the clinical course and outcomes of SARS-CoV-2 infection in patients affected by cancer. Methods: In this observational study, we collected clinical data from patients 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. Univariate and multivariate analyses were performed to explore the risk factors associated with severe events defined as hospitalisation, admission to an intensive care unit, mechanical ventilation or death. Results: Of the 64 patients included, 35 had available clinical data on medical and cancer history required for the analysis. Median age was 63 (47-86) years. Male were 22 (63%) and current or former smokers were 25 (76%). Lung was the most frequent site of primary tumor (15, 43%) or metastases (13, 37%). Out 26 (74%) patients 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 patients. The diagnosis of COVID-19 was only clinically 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%) patients, respectively. An antimicrobial treatment was administered in 19 patients. Eleven (31%) patients had severe events, death occurred in 7 (20%) cases. Higher risk for developing severe events was associated with active treatment with ICI (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: We confirmed the vulnerability of cancer patients to COVID-19. Although the sample size was small, treatment with ICI and lymphopenia seem to be risk factors for death and severe events. Screening cancer patients for infection is advisable, in particular before starting immunotherapy or in case of lymphopenia. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure All authors have declared no conflicts of interest.