Cytotoxic chemotherapy not linked to adverse COVID-19 outcomes
Recent cytotoxic chemotherapy treatment did not appear associated with adverse COVID-19 outcomes for patients with cancer, according to results of a retrospective study published in Journal of Clinical Oncology.
Patients with active hematologic or lung cancers, lymphopenia at the time of COVID-19 diagnosis, or baseline neutropenia generally had worse COVID-19 outcomes, researchers noted.
“It is important for patients to continue their chemotherapy to ensure the best outcomes from that treatment,” Melissa S. Pessin, MD, PhD, pathologist and chair of the department of laboratory medicine at Memorial Sloan Kettering Cancer Center, told Healio. “From our study, the chemotherapy treatment itself does not appear to cause additional adverse outcomes from having COVID-19. It’s important for patients to seek cancer therapy and not delay, as we have been seeing patients delay care and present at more advanced stages.”
An 18-patient retrospective study from China showed patients with cancer and COVID-19 seemed to have a higher risk for virus-related complications. A separate 105-patient study suggested lung cancer, metastatic disease and hematologic cancers may be associated with higher rates of COVID-19-related death and ICU admission.
Other studies analyzing cytotoxic chemotherapy in the era of COVID-19, however, have been mixed regarding whether the treatment increases risk for COVID-19-related mortality.
Pessin and colleagues analyzed clinical characteristics and outcomes of 309 patients (51.1% aged 60 years; 51.5% men; 64.4% white) with cancer and COVID-19 at Memorial Sloan Kettering Cancer Center to determine if cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis appeared associated with severe or critical COVID-19 illness.
Researchers also estimated associations between certain clinical and laboratory variables and incidence of a severe or critical COVID-19 event.
Results showed no significant association between cytotoxic chemotherapy and a severe or critical COVID-19 event (HR = 1.1; 95% CI, 0.73-1.6).
However, researchers observed associations between more severe or critical COVID-19 illness and hematologic malignancies (HR = 1.9; 95% CI, 1.3-2.8), lung cancer (HR = 2; 95% CI, 1.2-3.3) and lymphopenia at COVID-19 diagnosis (HR = 2.1; 95% CI, 1.5-3.1).
Those with baseline neutropenia 14 to 90 days prior to COVID-19 diagnosis also had worse outcomes (HR = 4.2; 95% CI, 1.7-11).
An analysis of a time-matched population of patients with cancer but without COVID-19 showed a lower rate of adverse events compared with patients with cancer and COVID-19.
“There are many ongoing studies examining the effects of the various forms of cancer treatments on the course of COVID-19 [among patients with cancer],” Pessin said. “Patients should discuss their concerns with their oncologist but, for most people, the potential benefits of their treatment will outweigh any additional potential risks with COVID-19 from that treatment. However, some treatment regimens may require modifications to further minimize risk.”
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Melissa S. Pessin, MD, PhD, can be reached at email@example.com.