Background COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared pandemic in March 2020. We know that patients with cancer represent a high risk population. Lung cancer have an already damage lung that may affect the evolution and outcomes of these patients.1–3 The aim of this study is to report the characteristics and outcomes of patients with lung cancer receiving immunotherapy and SARS-CoV-2 infection.
Methods We retrospectively collected sociodemographic and clinical data from patients with lung cancer and COVID-19 diagnosis who were admitted to La Paz University Hospital (Madrid, Spain) from March 1 to May 7, 2020. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Hazard ratios and corresponding 95% confidence intervals were estimated with the use of Cox proportional-hazards regression models.
Results A total of 29 patients were included. Baseline characteristics are depicted in table 1. Non-small-cell lung cancer (NSCLC) was reported in 93% of the patients and 69% were at advanced stage at the time of COVID-19 diagnosis. Eighty-two percent of the patients were admitted to the hospital and 75% received experimental therapy for COVID-19, including hydroxychloroquine (HCQ) (N=9), HCQ plus azithromycin (N=11) or lopinavir/ritonavir (N=2). A total of 12 patients developed acute distress respiratory syndrome (ADRS) at a median time of 7 days from COVID-19 diagnosis. ADRS was managed with steroids in 75% of the patients. Thirteen (44.8%) deaths were reported, 11 of them were considered to be COVID-19 related. Death occurred at a median time of 8 days. In the univariate analysis, diabetes mellitus, respiratory failure at the time of admission, presence of multilobar infiltrates and SDRA were associated with death.Twenty-two patients were on systemic treatment, of whom 10 patients were receiving immunotherapy alone (N=7) or in combination with chemotherapy (N=3) at the time of COVID-19 diagnosis. No significant association with the development of ADRS (P=0.38) or death (P=0.41) was found between patients on immunotherapy versus other systemic therapies. Overall survival was not reached in the immunotherapy group vs 14 days in patients on other systemic therapies (P=0.25), see figure 1.
Conclusions We found that patients with lung cancer represent an extremely vulnerable population, with a poor prognosis after COVID-19 diagnosis. Treatment with immunotherapy may also be considered a risk factor. Emphasis on prevention and treatment based on evidence-based medicine is crucial in our daily practice.
Acknowledgements This work has not been supported by public grants or financial support. No sources of funding were used to assist in the preparation of this manuscript
Ethics Approval The study was approved by Hospital Universitario La Paz Institution’s Ethics Board, approval number PI-4147
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