Abstract PO-031: Outcomes of COVID-19 in patients with lung cancer treated in a tertiary hospital in Madrid
Authors: Calles Antonio , Aparicio Inmaculada , Alva Manuel , Bringas Marianela , Gutierrez Natalia , Soto Javier , Galera Mar , Alvarez Rosa 
Published: December 2020

Background: Cancer patients represent a vulnerable population for COVID-19 illness. We aimed to analyze outcomes of lung cancer patients affected by COVID-19 in a tertiary hospital of a high-incidence region during the pandemic.

Methods: We retrospectively collected all lung cancer patients diagnosed with COVID-19 at our institution (HGUGM; Madrid, Spain) between February 24th, 2020 to May 12th, 2020. Patients must have a confirmatory SARS-CoV-2 RT-PCR to be included in the study. Clinically suspected cases and cases with close contact to COVID-19 confirmed cases were not included if either not tested or tested negative by RT-PCR.

Results: On March 4th, 2020, we confirmed our first lung cancer patient with COVID-19 in our institution. Since then, 23 lung cancer pts developed COVID-19 confirmed by SARS-CoV-2 PCR. Median age was 69 years-old (range 49-86), predominantly male (78%), with smoking history (former, 52%; current, 35%), and 87% presented comorbidities. Histology was 61% adenocarcinoma, 26% squamous cell carcinoma (SqCC), and 9% small-cell lung cancer (SCLC). Stage IV was the most commonly found (IVa 22%, IVb 39%), followed by stage III (35%) and stage I-II (4%). 70% of pts were receiving active treatment at the time of COVID-19 diagnosis (30-day window for systemic treatment, 15 days for radiation therapy): chemotherapy (n=4), immune checkpoint inhibitors (n=5), targeted therapy (n=1), thoracic chemo-radiation (n=1), and nonradical nonthoracic radiation therapy (n=6). All lung cancer patients had at least 1 COVID-19 related symptom; cough (48%), shortness of breath (48%), fever (39%), and low-grade fever (30%) were the most common COVID-19 symptoms. Time from symptoms onset to first positive SARS-CoV-2 PCR was 5.5 days (range 1-17), with 13% of cases needing a 2nd PCR to confirm diagnosis. High variability on thoracic imaging findings were found (no pneumonia, n=4; unilobar, n=1; multilobar, n=17). 87% of pts received treatment for COVID-19: hydroxychloroquine (n=20), lopinavir/ritonavir (n=17), azithromycin (n=3), interferon (n=3), and tocilizumab (n=1). In our series, hospitalization rate was 74%, and 39% of pts developed ARDS within 6 days after symptoms initiation (range 2-22 days). Only 1 patient was admitted in the ICU for VM and received tocilizumab and was discharged 42 days after admission. Case fatality rate was 35% (8/23), with 3 pts still on 30-day follow-up period. Considering only those patients with lung cancer who were actively receiving systemic therapy during the pandemic in our institution, we estimated a 4.5% incidence and a 2.1% mortality from COVID-19. Analysis of prognostic factors of mortality is under way.

Conclusions: Lung cancer patients represent a vulnerable population for COVID-19, according to the high rate of hospitalization, onset of ARDS, and high mortality rate. Although larger series are needed, no differences in mortality were found by type of cancer treatment. Measures to minimize the risk of SARS-CoV-2 infection remain key to protect lung cancer patients.

Citation Format: Antonio Calles, Inmaculada Aparicio, Manuel Alva, Marianela Bringas, Natalia Gutierrez, Javier Soto, Mar Galera, Rosa Alvarez. Outcomes of COVID-19 in patients with lung cancer treated in a tertiary hospital in Madrid [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-031.