Risk factors for COVID-19 severity and mortality among solid cancer patients and its impact on anticancer treatment: a nationwide cohort study (GCO-002 CACOVID-19)

Background Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated Patients and Methods In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and June 11, 2020 The primary endpoint was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary endpoints Results From April 4 to June 11, 2020, 1289 patients were analysed The most frequent cancers were digestive and thoracic Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died In multivariate analysis, independent factors associated with death were male sex (odds ratio 1 73, 95%CI: 1 18-2 52), ECOG PS ≥ 2 (OR 3 23, 95%CI: 2 27-4 61), updated Charlson comorbidity index (OR 1 08, 95%CI: 1 01-1 16) and admission to ICU (OR 3 62, 95%CI 2 14-6 11) The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except cytotoxic chemotherapy in the subgroup of patients with detectable SARS-CoV-2 by RT-PCR, which was associated with a slight increase of the risk of death (OR 1 53;95%CI: 1 00-2 34;p = 0 05) A total of 431 (39%) patients had their systemic anticancer treatment interrupted or stopped following diagnosis of COVID-19 Conclusions Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis