ASCO 2020: Global Consortiums CCC19, and TERAVOLT Improve Understanding of Cancer and COVID-19
By Sahana Shankar, Ph.D. Candidate
Clinicians from around the world analyzed the impact of COVID-19 on cancer patients to reveal risk factors and help them manage outcomes.
The COVID-19 pandemic has identified multiple groups of highly vulnerable individuals – the elderly, cancer patients, people with cardiovascular conditions, etc. These groups are at high risk owing to their physiological limitations, reduced immunity, and a higher probability of contact with the healthcare system, which may be currently overwhelmed by the volume of COVID-19 cases. Since data on the effect of COVID-19 on these groups is not readily available, ASCO members have successfully collated and characterized outcomes of cancer patients with COVID-19 and identified several prognostic factors for mortality and severe illnesses.
ASCO20 focused on our evolving understanding of the clinical impact of COVID-19 on cancer patients from two international collaborative clinical trials- the COVID-19 and Cancer Consortium (CCC19) and Thoracic cancERs international coVid-19 cOLlaboraTion (TERAVOLT).
Covid-19 and Cancer Consortium (CCC19)
CCC19 brings together cancer centers and other medical organizations to collect, organize, and curate data on cancer patients diagnosed with COVID-19 to understand their prognosis. CCC19 was founded as a collaborative effort of Advocate Aurora Health, Dana-Farber Cancer Institute (DF/HCC), Fred Hutchinson Cancer Research Center/University of Washington/Seattle Cancer Care Alliance, Sylvester Comprehensive Cancer Center at the University of Miami and Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center. Since its inception in March, the network now connects over 100 institutions to scale up real-time and rapid data analysis. Healthcare providers from partner centers in the US, EU, UK, Canada, and Argentina can report cases of current or historic malignancies coupled with COVID-19 diagnosis. The consortium is working on adding more participants from across the globe to enable a more in-depth analysis of COVID-19 and cancer.
Dr. Jeremy Warner of the Vanderbilt-Ingram Cancer Center showcased the first CCC19 study, which analyzed 928 cases from 104 institutions and described the anonymized cases. Fifty percent of the cases were male at a median age of 66 years. Thirty-nine percent of reported cases were on active anti-cancer treatment, while 43% of cases had active cancer. The distribution of cancer types showed that breast cancer was the most prevalent (21%), followed by prostate (14%), gastrointestinal (12%), blood (11%), and thoracic (10%). Half the cases were non-smokers, and two-third cases had an ECOG performance status of 0 or 1 (capable of light work).
Outcomes: The median duration of the study was 21 days, and 13% of patients died. The mortality rate in cancer patients is significantly higher than the global average. The analysis of the prognostic factors to better understand mortality outcomes revealed that active progressive cancer, male sex, age (75+), ECOG status 2+ (unable to carry out any work), former smoker were indicators. Subgroups of the elderly who were (a)intubated or (b)with ECOG status 2+ or (c) admitted to the ICU had higher mortality rates. Some initial data suggested an association of increased mortality with doses of azithromycin+hydroxychloroquine. However, this needs to be validated further.
Preliminary data from CCC19 improves our understanding of potential factors that can predict the outcomes of cancer patients with COVID-19. Increasing sample size and follow-up periods in the future will help characterize specific patient subsets and their specific responses to COVID-19.
TERAVOLT is a global consortium established by clinicians from the Vanderbilt-Ingram Cancer Center and Stanford University in the US, Ghent University Hospital in Belgium, Maastricht University in the Netherlands, Institute Gustave Roussy in France, Lausanne University, Switzerland and the National Cancer Institute of Milan, Italy in March 2020. They reported and analyzed patients with thoracic cancers and COVID-19 from over 25 countries to gather real-time data. The goal was to determine the demographic factors, comorbidities, cancer features, therapeutic options, and other risk factors, which may aid clinical strategies to improve survival in patients with thoracic cancers. It is an IRB (Institutional Review Board) approved Redcap fluid database with regular updates. Eligibility criteria were patients with thoracic malignancies and COVID-19 confirmed by RT-PCR, clinical and radiographic findings.
The first report on the first 200 patients (mostly from Europe) enrolled in the database was presented by one of the lead investigators, Dr. Marina Garassino. The study with a median follow-up of 15 days showed that advanced age was a risk factor in lung cancer patients on active therapy. Thirty-three percent of the patients died due to COVID-19 related complications.
The more extensive study presented by Dr. Leora Horn from the Vanderbilt-Ingram Cancer Center focussed on the next 400 patients with a few tweaks to the analysis methodology. The median of 33 days, association studies between cancer type, stage, therapy on COVID-19 outcome, analysis of comorbidities, and line of treatment were additional parameters. The median age of enrolled patients was 70 years (typical of the average lung cancer population), and the majority were male. Forty percent of patients were in recovery from cancer, 27% were undergoing treatment, and 33% died. Of the deaths, 79.4% of deaths were due to COVID-19. Most of the patients had non-small cell lung cancer (NSCLC), and 60-75% of patients were at stage IV of cancer. 45% of patients who died were on chemotherapy.
The key risk factors associated with mortality were age (>65 years), comorbidities, ECOG performance status >1, steroids more than 10mg/day, and chemotherapy. However, immunotherapy and Tyrosine Kinase inhibitors do not impact mortality. The line of treatment for COVID-19 does not alter outcomes.
TERAVOLT has been endorsed by multiple scientific societies to increase participation and improve the perception of the impact of COVID-19 on thoracic cancers.
Editor: Rajaneesh K. Gopinath, Ph.D.
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