Outcomes of COVID-19 in patients withlung cancer treated in a tertiary hospital in Madrid
Authors: Antonio Calles, Inmaculada Aparicio, Manuel Alva, Marianela Bringas, Natalia Gutierrez, Javier Soto, Mar Galera, Rosa Alvarez
Journal: Clinical Cancer Research (2020)

Background: Cancer patients represent a vulnerable population for COVID-19 illness  We aimed to analyzeoutcomes of lung cancer patients affected by COVID-19 in a tertiary hospital of a high-incidence region during thepandemic  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 confirmatorySARS-CoV-2 RT-PCR to be included in the study  Clinically suspected cases and cases with close contact toCOVID-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  Sincethen, 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% presentedcomorbidities  Histology was 61% adenocarcinoma, 26% squamous cell carcinoma (SqCC), and 9% small-cell lungcancer (SCLC)  Stage IV was the most commonly found (IVa 22%, IVb 39%), followed by stage III (35%) and stageI-II (4%)  70% of pts were receiving active treatment at the time of COVID-19 diagnosis (30-day window for systemictreatment, 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 patientshad at least 1 COVID-19 related symptom;cough (48%), shortness of breath (48%), fever (39%), and low-gradefever (30%) were the most common COVID-19 symptoms  Time from symptoms onset to first positive SARS-CoV-2PCR was 5 5 days (range 1-17), with 13% of cases needing a 2nd PCR to confirm diagnosis  High variability onthoracic imaging findings were found (no pneumonia, n=4;unilobar, n=1;multilobar, n=17)  87% of pts receivedtreatment 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 daysafter symptoms initiation (range 2-22 days)  Only 1 patient was admitted in the ICU for VM and received tocilizumaband was discharged 42 days after admission  Case fatality rate was 35% (8/23), with 3 pts still on 30-day follow-upperiod  Considering only those patients with lung cancer who were actively receiving systemic therapy during thepandemic in our institution, we estimated a 4 5% incidence and a 2 1% mortality from COVID-19  Analysis ofprognostic factors of mortality is under way  Conclusions: Lung cancer patients represent a vulnerable population for COVID-19, according to the high rate ofhospitalization, onset of ARDS, and high mortality rate  Although larger series are needed, no differences inmortality were found by type of cancer treatment  Measures to minimize the risk of SARS-CoV-2 infection remainkey to protect lung cancer patients