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COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study.
Lancet Oncol. 2020 07; 21(7):914-922.LO

Abstract

BACKGROUND

Early reports on patients with cancer and COVID-19 have suggested a high mortality rate compared with the general population. Patients with thoracic malignancies are thought to be particularly susceptible to COVID-19 given their older age, smoking habits, and pre-existing cardiopulmonary comorbidities, in addition to cancer treatments. We aimed to study the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on patients with thoracic malignancies.

METHODS

The Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry is a multicentre observational study composed of a cross-sectional component and a longitudinal cohort component. Eligibility criteria were the presence of any thoracic cancer (non-small-cell lung cancer [NSCLC], small-cell lung cancer, mesothelioma, thymic epithelial tumours, and other pulmonary neuroendocrine neoplasms) and a COVID-19 diagnosis, either laboratory confirmed with RT-PCR, suspected with symptoms and contacts, or radiologically suspected cases with lung imaging features consistent with COVID-19 pneumonia and symptoms. Patients of any age, sex, histology, or stage were considered eligible, including those in active treatment and clinical follow-up. Clinical data were extracted from medical records of consecutive patients from Jan 1, 2020, and will be collected until the end of pandemic declared by WHO. Data on demographics, oncological history and comorbidities, COVID-19 diagnosis, and course of illness and clinical outcomes were collected. Associations between demographic or clinical characteristics and outcomes were measured with odds ratios (ORs) with 95% CIs using univariable and multivariable logistic regression, with sex, age, smoking status, hypertension, and chronic obstructive pulmonary disease included in multivariable analysis. This is a preliminary analysis of the first 200 patients. The registry continues to accept new sites and patient data.

FINDINGS

Between March 26 and April 12, 2020, 200 patients with COVID-19 and thoracic cancers from eight countries were identified and included in the TERAVOLT registry; median age was 68·0 years (61·8-75·0) and the majority had an Eastern Cooperative Oncology Group performance status of 0-1 (142 [72%] of 196 patients), were current or former smokers (159 [81%] of 196), had non-small-cell lung cancer (151 [76%] of 200), and were on therapy at the time of COVID-19 diagnosis (147 [74%] of 199), with 112 (57%) of 197 on first-line treatment. 152 (76%) patients were hospitalised and 66 (33%) died. 13 (10%) of 134 patients who met criteria for ICU admission were admitted to ICU; the remaining 121 were hospitalised, but were not admitted to ICU. Univariable analyses revealed that being older than 65 years (OR 1·88, 95% 1·00-3·62), being a current or former smoker (4·24, 1·70-12·95), receiving treatment with chemotherapy alone (2·54, 1·09-6·11), and the presence of any comorbidities (2·65, 1·09-7·46) were associated with increased risk of death. However, in multivariable analysis, only smoking history (OR 3·18, 95% CI 1·11-9·06) was associated with increased risk of death.

INTERPRETATION

With an ongoing global pandemic of COVID-19, our data suggest high mortality and low admission to intensive care in patients with thoracic cancer. Whether mortality could be reduced with treatment in intensive care remains to be determined. With improved cancer therapeutic options, access to intensive care should be discussed in a multidisciplinary setting based on cancer specific mortality and patients' preference.

FUNDING

None.

Authors+Show Affiliations

Thoracic Unit, Medical Oncology Department, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: marina.garassino@istitutotumori.mi.it.Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Evaluative Epidemiology, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.Laboratory of Clinical Research Methodology, Oncology Department, "Mario Negri" Institute of Pharmacological Researches-IRCCS, Milan, Italy.Medical Oncology Department, Fondazione IRCCS Policlinico "San Matteo", Pavia, Italy.Medical Oncology Department, Thoracic Cancer and Early Drug Development Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.Department of Oncology, Portsmouth Hospitals NHS Trust, Portsmouth, UK.Medical Oncology Department, AOU Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.Medical Oncology Department, ASST Cremona, Cremona, Italy.Hopital Tenon, Paris, France.Thoracic Unit, Medical Oncology Department, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.Oncology Unit, ASST dei Sette Laghi, Varese, Italy.Department of Biotechnology and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy.Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.IRYCIS, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.IRCCS Ospedale Policlinico San Martino, Genova, Italy.Medical Oncology Unit, Sant'Andrea Hospital, Rome, Italy.Department of Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.Medical Oncology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.Mesothelioma Unit, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.Medical Oncology Department, ASST Spedali Civili di Brescia, Brescia, Italy.Medical Oncology Department, ASST Fatebenefratelli Sacco, Milan, Italy.Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.CHU, Institut universitaire du cancer, Toulouse, France.Thoracic Surgery Unit, Experimental Clinical Oncology Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy.Oncology Department, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland.Department of Oncology and Hematology, AUSL della Romagna, Ravenna, Italy.Service Hospitalier Universitaire Pneumologie Physiologie, CHU Grenoble-Alpes, Grenoble, France.Istituto Oncologico Veneto IRCCS, Padova, Italy.European Institute of Oncology, European Institute of Oncology IRCCS, Milan, Italy.Radiotherapy Unit V Scotti, Thoracic Surgery Unit L Voltolini, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.Thoracic Surgery, Policlinico S Orsola, Alma Mater Studiorum University, Bologna, Italy.Medical Oncology Unit, Ospedale "Guglielmo da Saliceto", Piacenza, Italy.Department of Medicine and Surgery, University of Parma, University Hospital of Parma, Parma, Italy.Thoracic Unit, Medical Oncology Department, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.Radiotherapy Unit V Scotti, Thoracic Surgery Unit L Voltolini, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.Guangdong Lung Cancer Department, Guangdong General Hospital, Guangzhou, China.Medical Oncology Department, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.Centre de Recherche en Cancérologie de Toulouse, Toulouse, France.Department of Pulmonology, Erasmus University Medical Center, Rotterdam, University Maastricht, Maastricht, Netherlands.Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium.Gustave Roussy Institute, Villejuif, Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France.Stanford Cancer Institute, Stanford University, Stanford, CA, USA.Oncology Department, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland.Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

32539942

Citation

Garassino, Marina Chiara, et al. "COVID-19 in Patients With Thoracic Malignancies (TERAVOLT): First Results of an International, Registry-based, Cohort Study." The Lancet. Oncology, vol. 21, no. 7, 2020, pp. 914-922.
Garassino MC, Whisenant JG, Huang LC, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020;21(7):914-922.
Garassino, M. C., Whisenant, J. G., Huang, L. C., Trama, A., Torri, V., Agustoni, F., Baena, J., Banna, G., Berardi, R., Bettini, A. C., Bria, E., Brighenti, M., Cadranel, J., De Toma, A., Chini, C., Cortellini, A., Felip, E., Finocchiaro, G., Garrido, P., ... Horn, L. (2020). COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. The Lancet. Oncology, 21(7), 914-922. https://doi.org/10.1016/S1470-2045(20)30314-4
Garassino MC, et al. COVID-19 in Patients With Thoracic Malignancies (TERAVOLT): First Results of an International, Registry-based, Cohort Study. Lancet Oncol. 2020;21(7):914-922. PubMed PMID: 32539942.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. AU - Garassino,Marina Chiara, AU - Whisenant,Jennifer G, AU - Huang,Li-Ching, AU - Trama,Annalisa, AU - Torri,Valter, AU - Agustoni,Francesco, AU - Baena,Javier, AU - Banna,Giuseppe, AU - Berardi,Rossana, AU - Bettini,Anna Cecilia, AU - Bria,Emilio, AU - Brighenti,Matteo, AU - Cadranel,Jacques, AU - De Toma,Alessandro, AU - Chini,Claudio, AU - Cortellini,Alessio, AU - Felip,Enriqueta, AU - Finocchiaro,Giovanna, AU - Garrido,Pilar, AU - Genova,Carlo, AU - Giusti,Raffaele, AU - Gregorc,Vanesa, AU - Grossi,Francesco, AU - Grosso,Federica, AU - Intagliata,Salvatore, AU - La Verde,Nicla, AU - Liu,Stephen V, AU - Mazieres,Julien, AU - Mercadante,Edoardo, AU - Michielin,Olivier, AU - Minuti,Gabriele, AU - Moro-Sibilot,Denis, AU - Pasello,Giulia, AU - Passaro,Antonio, AU - Scotti,Vieri, AU - Solli,Piergiorgio, AU - Stroppa,Elisa, AU - Tiseo,Marcello, AU - Viscardi,Giuseppe, AU - Voltolini,Luca, AU - Wu,Yi-Long, AU - Zai,Silvia, AU - Pancaldi,Vera, AU - Dingemans,Anne-Marie, AU - Van Meerbeeck,Jan, AU - Barlesi,Fabrice, AU - Wakelee,Heather, AU - Peters,Solange, AU - Horn,Leora, AU - ,, Y1 - 2020/06/12/ PY - 2020/04/23/received PY - 2020/05/20/revised PY - 2020/05/21/accepted PY - 2020/6/17/pubmed PY - 2020/7/18/medline PY - 2020/6/17/entrez SP - 914 EP - 922 JF - The Lancet. Oncology JO - Lancet Oncol VL - 21 IS - 7 N2 - BACKGROUND: Early reports on patients with cancer and COVID-19 have suggested a high mortality rate compared with the general population. Patients with thoracic malignancies are thought to be particularly susceptible to COVID-19 given their older age, smoking habits, and pre-existing cardiopulmonary comorbidities, in addition to cancer treatments. We aimed to study the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on patients with thoracic malignancies. METHODS: The Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry is a multicentre observational study composed of a cross-sectional component and a longitudinal cohort component. Eligibility criteria were the presence of any thoracic cancer (non-small-cell lung cancer [NSCLC], small-cell lung cancer, mesothelioma, thymic epithelial tumours, and other pulmonary neuroendocrine neoplasms) and a COVID-19 diagnosis, either laboratory confirmed with RT-PCR, suspected with symptoms and contacts, or radiologically suspected cases with lung imaging features consistent with COVID-19 pneumonia and symptoms. Patients of any age, sex, histology, or stage were considered eligible, including those in active treatment and clinical follow-up. Clinical data were extracted from medical records of consecutive patients from Jan 1, 2020, and will be collected until the end of pandemic declared by WHO. Data on demographics, oncological history and comorbidities, COVID-19 diagnosis, and course of illness and clinical outcomes were collected. Associations between demographic or clinical characteristics and outcomes were measured with odds ratios (ORs) with 95% CIs using univariable and multivariable logistic regression, with sex, age, smoking status, hypertension, and chronic obstructive pulmonary disease included in multivariable analysis. This is a preliminary analysis of the first 200 patients. The registry continues to accept new sites and patient data. FINDINGS: Between March 26 and April 12, 2020, 200 patients with COVID-19 and thoracic cancers from eight countries were identified and included in the TERAVOLT registry; median age was 68·0 years (61·8-75·0) and the majority had an Eastern Cooperative Oncology Group performance status of 0-1 (142 [72%] of 196 patients), were current or former smokers (159 [81%] of 196), had non-small-cell lung cancer (151 [76%] of 200), and were on therapy at the time of COVID-19 diagnosis (147 [74%] of 199), with 112 (57%) of 197 on first-line treatment. 152 (76%) patients were hospitalised and 66 (33%) died. 13 (10%) of 134 patients who met criteria for ICU admission were admitted to ICU; the remaining 121 were hospitalised, but were not admitted to ICU. Univariable analyses revealed that being older than 65 years (OR 1·88, 95% 1·00-3·62), being a current or former smoker (4·24, 1·70-12·95), receiving treatment with chemotherapy alone (2·54, 1·09-6·11), and the presence of any comorbidities (2·65, 1·09-7·46) were associated with increased risk of death. However, in multivariable analysis, only smoking history (OR 3·18, 95% CI 1·11-9·06) was associated with increased risk of death. INTERPRETATION: With an ongoing global pandemic of COVID-19, our data suggest high mortality and low admission to intensive care in patients with thoracic cancer. Whether mortality could be reduced with treatment in intensive care remains to be determined. With improved cancer therapeutic options, access to intensive care should be discussed in a multidisciplinary setting based on cancer specific mortality and patients' preference. FUNDING: None. SN - 1474-5488 UR - https://www.unboundmedicine.com/medline/citation/32539942/COVID_19_in_patients_with_thoracic_malignancies__TERAVOLT_:_first_results_of_an_international_registry_based_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1470-2045(20)30314-4 DB - PRIME DP - Unbound Medicine ER -