Changes Over Time in COVID-19 Severity and Mortality in Patients Undergoing Cancer Treatment in the United States: Initial Report From the ASCO Registry

Kathryn F Mileham, Suanna S Bruinooge, Charu Aggarwal, Alicia L Patrick, Christiana Davis, Daniel J Mesenhowski, Alexander Spira, Eric J Clayton, David Waterhouse, Susan Moore, Abdul-Rahman Jazieh, Ronald C Chen, Melinda Kaltenbaugh, Jen Hanley Williams, Julie R Gralow, Richard L Schilsky, Elizabeth Garrett-Mayer, Kathryn F Mileham, Suanna S Bruinooge, Charu Aggarwal, Alicia L Patrick, Christiana Davis, Daniel J Mesenhowski, Alexander Spira, Eric J Clayton, David Waterhouse, Susan Moore, Abdul-Rahman Jazieh, Ronald C Chen, Melinda Kaltenbaugh, Jen Hanley Williams, Julie R Gralow, Richard L Schilsky, Elizabeth Garrett-Mayer

Abstract

Purpose: People with cancer are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ASCO's COVID-19 registry promotes systematic data collection across US oncology practices.

Methods: Participating practices enter data on patients with SARS-CoV-2 infection in cancer treatment. In this analysis, we focus on all patients with hematologic or regional or metastatic solid tumor malignancies. Primary outcomes are 30- and 90-day mortality rates and change over time.

Results: Thirty-eight practices provided data for 453 patients from April to October 2020. Sixty-two percent had regional or metastatic solid tumors. Median age was 64 years. Forty-three percent were current or previous cigarette users. Patients with B-cell malignancies age 61-70 years had twice mortality risk (hazard ratio = 2.1 [95% CI, 1.3 to 3.3]) and those age > 70 years had 4.5 times mortality risk (95% CI, 1.8 to 11.1) compared with patients age ≤ 60 years. Association between survival and age was not significant in patients with metastatic solid tumors (P = .12). Tobacco users had 30-day mortality estimate of 21% compared with 11% for never users (log-rank P = .005). Patients diagnosed with SARS-CoV-2 before June 2020 had 30-day mortality rate of 20% (95% CI, 14% to 25%) compared with 13% (8% to 18%) for those diagnosed in or after June 2020 (P = .08). The 90-day mortality rate for pre-June patients was 28% (21% to 34%) compared with 21% (13% to 28%; P = .20).

Conclusion: Older patients with B-cell malignancies were at increased risk for death (unlike older patients with metastatic solid tumors), as were all patients with cancer who smoke tobacco. Diagnosis of SARS-CoV-2 later in 2020 was associated with more favorable 30- and 90-day mortality, likely related to more asymptomatic cases and improved clinical management.

Conflict of interest statement

Kathryn F. MilehamHonoraria: Bristol Myers Squibb, RegeneronConsulting or Advisory Role: AstraZeneca, Bayer, Merck Charu AggarwalConsulting or Advisory Role: Genentech, Lilly, Celgene, Merck, AstraZeneca, Blueprint Genetics, Shionogi, Daiichi Sankyo/Astra ZenecaSpeakers' Bureau: AstraZeneca (I), Roche/Genentech (I)Research Funding: Genentech/Roche (Inst), Incyte (Inst), Macrogenics (Inst), Merck Sharp & Dohme (Inst), AstraZeneca/MedImmune (Inst) Daniel J. MesenhowskiEmployment: Virginia Cancer Specialists Alexander SpiraLeadership: NEXT Oncology Virginia (Inst)Stock and Other Ownership Interest: LillyHonoraria: CytomX Therapeutics, AstraZeneca/MedImmune, Merck, Takeda, Amgen, Janssen Oncology, Novartis, Bristol Myers Squibb, BayerConsulting or Advisory Role: Array BioPharma (Inst), Incyte, Amgen, Novartis, AstraZeneca/MedImmune (Inst), Mirati Therapeutics, Gritstone Oncology, Jazz Pharmaceuticals, Merck (Inst), Bristol Myers Squibb (Inst), Takeda, Janssen Research & DevelopmentResearch Funding: Roche (Inst), AstraZeneca (Inst), Boehringer Ingelheim (Inst), Astellas Pharma (Inst), MedImmune (Inst), Novartis (Inst), Newlink Genetics (Inst), Incyte (Inst), AbbVie (Inst), Ignyta (Inst), LAM Therapeutics (Inst), Trovagene (Inst), Takeda (Inst), Macrogenics (Inst), CytomX Therapeutics (Inst), Astex Pharmaceuticals (Inst), Bristol-Myers Squibb (Inst), Loxo (Inst), Arch Therapeutics (Inst), Gritstone Oncology (Inst), Plexxikon (Inst), Amgen (Inst), Daiichi Sankyo (Inst), ADC Therapeutics (Inst), Janssen Oncology (Inst), Mirati Therapeutics (Inst), Rubius Therapeutics (Inst) Eric J. ClaytonEmployment: US Oncology, HCA HealthcareStock and Other Ownership Interests: HCA HealthcareResearch Funding: US OncologyTravel, Accommodations, Expenses: US Oncology David WaterhouseConsulting or Advisory Role: Bristol Myers Squibb, AZTherapies, AbbVie, Amgen, McGivney Global Advisors, Janssen Oncology, Seattle Genetics, Jazz Pharmaceuticals, Exelixis, Eisai, EMD Serono, Merck, Pfizer, Mirati Therapeutics, Regeneron/SanofiSpeakers' Bureau: Bristol-Myers Squibb, Janssen Oncology, Merck, AstraZeneca, Amgen, EMD SeronoTravel, Accommodations, Expenses: Bristol Myers Squibb Abdul-Rahman JaziehStock and Other Ownership Interests: Innovative Healthcare InstituteResearch Funding: MSD Oncology, AstraZeneca, PfizerTravel, Accommodations, Expenses: Bristol Myers SquibbOther Relationship: MSD (Inst) Ronald C. ChenConsulting or Advisory Role: Medivation/Astellas, Accuray, Bayer, Blue Earth Diagnostics, AbbVie, Myovant Sciences, Genentech, PfizerResearch Funding: Accuray Julie R. GralowConsulting or Advisory Role: Genentech, AstraZeneca, Hexal, Puma Biotechnology, Roche, Novartis, Seagen, Genomic Health Richard L. SchilskyLeadership: ClariifiConsulting or Advisory Role: Cellworks, Scandion Oncology, BryologyxResearch Funding: AstraZeneca (Inst), Bayer (Inst), Bristol Myers Squibb (Inst), Genentech/Roche (Inst), Lilly (Inst), Merck (Inst), Pfizer (Inst), Boehringer Ingelheim (Inst), Seattle Genetics (Inst)Open Payments Link: https://openpaymentsdata.cms.gov/physician/1138818/summary Elizabeth Garrett-MayerConsulting or Advisory Role: DecipheraNo other potential conflicts of interest were reported.

Figures

FIG 1.
FIG 1.
OS by age in (A) all patients (P = .001), (B) patients with B-cell malignancy (P = .002), and (C) patients with metastatic solid tumors (P = .40). HR, hazard ratio; OS, overall survival.
FIG 2.
FIG 2.
Mortality rates in patients with positive severe acute respiratory syndrome coronavirus 2 test (A) before June (n = 191) or (B) in or after June (n = 262). aFor immunotherapy, at least one component was immunotherapy. For cytotoxic chemotherapy, at least one component was chemotherapy, and none were immunotherapy. For Other, No drug-based components were chemotherapy or immunotherapy. ICU, intensive care unit.
FIG A1.
FIG A1.
Study calendar for patients in ASCO survey on COVID-19 in Oncology Registry. The Registry was changed in August 2021 to add data collection for at 18 and 24 months after positive SARS-CoV-2 test. The full ASCO Registry protocol schema is available at https://www.asco.org/asco-coronavirus-information/coronavirus-registry. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
FIG A2.
FIG A2.
CONSORT diagram for registry patients selected for analysis.
FIG A3.
FIG A3.
COVID-19 interventions in patients diagnosed with severe acute respiratory syndrome coronavirus 2 before or after June 2020. Estimated percentages remove unknown percentages for each category of intervention from the percentage that is reported (Table 1). ICU, intensive care unit.
FIG A4.
FIG A4.
Thirty- and 90-day mortality estimates by patient subgroups. ICI, immune checkpoint inhibitor; ICU, intensive care unit.

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