New insights about COVID-19 treatments for cancer patients
The COVID-19 and Cancer Consortium (CCC19), which includes the Mays Cancer Center, home to UT Health San Antonio MD Anderson, announced results July 22 of its second national observational study. The study compares the outcomes of cancer patients diagnosed with COVID-19 to the treatments they received.
Patients who were treated with the antiviral drug remdesivir fared the best, while patients who received hydroxychloroquine in combination with other drugs showed no benefit. The study also showed increased deaths among cancer patients who received dexamethasone, a steroid that has had a positive effect in the general population with COVID-19.
Dimpy Shah, MD, PhD, is a co-author of the study published in the journal Cancer Discovery. She is an assistant professor in the Department of Population Health Sciences and a member of the Mays Cancer Center.
“Although prospective, randomized trials are absolutely essential to understand the impact of drugs on preventing COVID-19 outcomes, high-quality observational studies provide evidence on drugs necessary for clinical practice in the pandemic. With this study, we employed extensive statistical analysis to understand these therapies and identified no evidence that hydroxychloroquine prevents COVID-19 related deaths,” said Dr. Shah, a member of the CCC-19 Steering Committee and co-leader of the consortium’s Epidemiology and Statistics Committee.
The study includes data on 2,186 adults in the United States and is the largest cancer-specific observational study to date of treatments purported to improve COVID-19 outcomes. The data were published shortly after a keynote address by Solange Peters, MD, PhD, at the American Association for Cancer Research Virtual Meeting: COVID-19 and Cancer. Dr. Peters is president of the European Society for Medical Oncology and one of the study’s lead authors.
In this updated report from the CCC19, the consortium’s researchers confirm and expand upon earlier observations that there was broad use of unproven COVID-19 therapies, almost all of which were outside of clinical trials.
Overall, the steroid dexamethasone lowered the death rate among critically ill patients, according to data from the RECOVERY trial in the United Kingdom, but the CCC19 data showed increased deaths among cancer patients who were given the drug. In the CCC19 analysis, patients receiving high-dose corticosteroids with any other potential COVID-19 treatment were more than twice as likely to die, compared to patients treated with other medications or patients not requiring any treatment. There were very small numbers of patients treated just with steroids, making analysis of steroids in isolation difficult.
“There is so much enthusiasm about dexamethasone, but our findings in a relatively small subgroup suggest that steroids could be associated with increased mortality in the cancer population,” said Jeremy Warner, MD, MS, associate professor of Medicine and Biomedical Informatics at Vanderbilt University, the study’s corresponding author. “This does have some rational explanation, since cancer is already an immunocompromised state and steroids could potentially make things worse. The RECOVERY trial is the first to show a survival benefit for any treatment of COVID-19, but that study, just published in The New England Journal of Medicine, does not provide details for the subgroup of patients with cancer.”
This is the second study and release of data by CCC19. While the mortality rate among cancer patients affected by COVID-19 was 13% in the CCC19’s prior study of 928 patients, the rate was 16% in the newly published study, which involved 2,186 patients.
Remdesivir, which was primarily available as a clinical trial option, was associated with a lower death rate when compared to patients receiving any other potential COVID-19 treatment.
See the study for complete information, including a list of the 45 co-authors: https://cancerdiscovery.aacrjournals.org/content/early/2020/07/21/2159-8290.CD-20-0941