Developing a risk assessment score for cancer patients during the COVID-19 pandemic

ABSTRACT

Background: Data on the novel coronavirus (CoV) respiratory disease (COVID-19) in cancer patients (pts) are limited. In some individuals, CoV infection triggers an aberrant inflammatory response, leading to lung tissue damage. Cancer pts treated with immunotherapy (IT) may therefore be more at risk for COVID-19 infection and related complications. Methods: We performed a thorough review of the literature on CoV pathogenesis and cancer, selecting shared features of the two disease entities to develop a risk-assessment score to quantify both the risk of infection and the risk implied in cancer treatment delays. Results: The score includes clinical and laboratory variables (Table). Pts' characteristics include age, presence of comorbidities (hypertension, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, chronic systemic infections), obesity, sex, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and concomitant steroid treatment (>10 mg daily of prednisone equivalent, lasting for >1-month period). Disease characteristics include lung cancer diagnosis, history of thoracic radiotherapy (RT) (only for pts with extra-thoracic tumours). Treatment characteristics include line of treatment, type (IT or combined IT/chemotherapy [CT] considered high-risk, followed by CT, and other anticancer drugs), history of immune-related adverse events (irAEs). Laboratory tests include levels of neutrophil-to-lymphocite ratio (NLR), lactate-dehydrogenase (LDH), and C-reactive protein (CRP). Based on the resulting score, pts can be divided in the following categories of risk low (score <4), intermediate (score 4-6), and high risk (score >7). [Formula presented] Conclusions: There is a strong rationale supporting the presented data as potential risk factors for COVID-19 in cancer pts. The present score is currently undergoing validation on a wide population of cancer pts to confirm its role and potentially help physicians’ treatment decisions. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure All authors have declared no conflicts of interest.