First results of the COCO study: COVID-19 outcomes in patients with cancer

ABSTRACT

Background: COVID-19 pandemic has drastically changed the management of patients with cancer;however, limited data exists regarding which pre-conditions affect the course of COVID-19 infection. Here, we sought to assess the clinical features and outcomes of COVID-19 infection in a large cohort of patients with cancer. Methods: We conducted a multicenter retrospective cohort study of patients with cancer diagnosed with SARS-CoV-2 infection by RT-PCR/Ag detection (n=274) or CT-scan (N=13) between 7/March and 30/April across 12 international centers. Clinical, pathological and biological data were collected. Primary endpoints were 30-day mortality rate and the rate of severe acute respiratory failure (SARF), defined by oxygen requirements >15 L/min. Descriptive statistics were used. Results: 287 patients were enrolled with a median follow-up of 23 days [95%CI 22-26]. Median age was 69 (range 35-98), 52% were male, 49% had hypertension and 23% had cardiovascular disease. As per cancer characteristics, 68% had active disease, 52% advanced stage and 79% had a baseline ECOG PS ≤1. Most frequent cancer-types were 26% thoracic, 21% gastrointestinal, 19% breast and 15% genitourinary. Most patients (61%) were under systemic therapy, including chemotherapy (51%), endocrine therapy (23%) and immunotherapy (19%). At COVID-19 diagnosis, 44% of patients had moderate/severe symptoms such as fever (70%), cough (54%) and dyspnea (48%). The majority of patients (90%) required in-patient management and the median hospital stay duration was 10 days (range 1-52);8% of patients required intermediate or intensive care unit admission. Patients received treatment with hydroxychloroquine (81%), azithromycin (61%), antiviral therapy (38%) and immunomodulatory drugs (14%). Finally, the overall mortality rate was 27% and the rate of SARF was 26%. In patients admitted to intermediate/intensive care units, the mortality and SARF rates were 45% and 73%, respectively. Mortality rate according to ECOG PS before COVID-19 was 20% in PS≤1 and 51% in PS>2 (p<0.0001). Conclusions: Patients with cancer are a susceptible population with a high likelihood of severe complications and high mortality from COVID-19 infection. Final results and treatment outcomes will be presented at the ESMO Congress. Legal entity responsible for the study Aleix Prat. Funding: Has not received any funding. Disclosure E. Auclin Travel/Accommodation/Expenses Mundipharma;Speaker Bureau/Expert testimony Sanofi Genzymes. S. Pilotto Speaker Bureau/Expert testimony Astra-Zeneca;Eli-Lilly;BMS;Boehringer Ingelheim;MSD;Roche. L. Mezquita Speaker Bureau/Expert testimony, Research grant/Funding (self), Travel/Accommodation/Expenses Bristol-Myers Squibb;Speaker Bureau/Expert testimony Tecnofarma;Speaker Bureau/Expert testimony, Non-remunerated activity/ies AstraZeneca;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses Roche;Research grant/Funding (self) Boehringer Ingelheim. A. Prat Honoraria (institution), Speaker Bureau/Expert testimony Roche;Daiichi Sankyo;Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony Pfizer;Novartis;Amgen;Speaker Bureau/Expert testimony BMS;Advisory/Consultancy Puma;Oncolytics Biotech;MSD;Honoraria (institution), Advisory/Consultancy Lilly;Honoraria (institution), Speaker Bureau/Expert testimony Nanostring technologies;Officer/Board of Directors Breast International Group;Officer/Board of Directors Solti's Foundation;Leadership role Actitud Frente al Cancer Foundation;Honoraria (institution) Boehringer;Honoraria (institution) Sysmex Europa GmbH;Honoraria (institution) Medica Scientia inno. Research;Honoraria (institution) Celgene;Honoraria (institution) Astellas Pharma. All other authors have declared no conflicts of interest.