First results from the TERAVOLT (Thoracic cancERs international coVid 19 cOLlaboraTion) registry for thoracic cancers indicate an unexpectedly high mortality rate of COVID-19 in patients with thoracic malignancies.
The data, presented today at the American Association for Cancer Research (AACR) Virtual Annual Meeting by Dr Marina Chiara Garassino from Fondazione IRCCS Istituto Nazionale Tumori in Milan, Italy, includes the results for the first 200 patients enrolled in the registry up to 12 April 2020, and represents the first large dataset for patients with thoracic cancers infected with COVID-19.
Previously published data has suggested a higher prevalence of COVID-19 in patients with lung cancer compared to other tumours (ref) and has indicated that cancer patients and survivors may be at higher risk of COVID-19 infection compared to the general population (ref 1, 2).
The TERAVOLT registry was launched in March with the aim of gathering information on patients with thoracic cancer infected with COVID-19 regardless of therapies administered. This global collaboration involves 21 countries worldwide and is endorsed by a number of international societies including ESMO. Any thoracic cancer patients diagnosed with COVID-19 infection through RT-PCR laboratory tests or with suspected COVID-19 infection based on exposure and symptoms are eligible for inclusion in the registry.
For the first 200 patients in the registry, the median age was 68 years, with the majority of patients being male and current/former smokers; 73.5% had Stage IV disease and 75.5% had NSCLC. Patients with SCLC (14.5%) and rare thoracic malignancies were also included in the registry. At least one comorbidity was observed in 83.8% of patients, with hypertension being the most common comorbidity (47%), followed by COPD (25.8%).
Most patients were receiving treatment (73.9%), mainly chemotherapy alone (32.7%), immunotherapy alone (23.1%) or TKI alone (19%). The clinical presentation of COVID-19 showed a similar profile to lung cancer symptoms, with the most common symptoms being fever, cough, dyspnea, making diagnosis of the virus challenging. The most common complications were pneumonia/ pneumonitis (79.6%) and Acute Respiratory Distress Syndrome (26.8%).
The majority of patients were hospitalized (76%) and 34.6% of these patients died. Most patients were not admitted to Intensive Care Units (ICUs), although the reasons for this remain unclear. Univariate analysis did not show an association with any specific cancer treatment and an increased risk of death. Multivariate analysis adjusted for the most important risk factors in the general population did not identify a risk profile for COVID-19 mortality in thoracic cancer patients.
Dr Garassino concluded that although the mortality rate of COVID-19 in thoracic cancer patients was unexpectedly high, this does not appear to be associated with any specific type of treatment or comorbidity. Most of these deaths were caused by SARS-CoV2 infection and not cancer, and no risk profile was identified for death in thoracic cancer patients diagnosed with COVID-19 infection.
Major limitations of the study include the short follow up and selected patient population, but Dr Garassino highlighted the strong, united response from the international thoracic community which has allowed activation of the registry and generation of data in a short period of time.