Transcript
I'm Dr Petros Grivas. I'm a Medical Oncologist at Seattle Cancer Care Alliance. I'm an Associate Professor at University of Washington and Fred Hutchinson Cancer Research Center.
Important dataset that is good to discuss is the huge effort from the COVID-19 and Cancer Consortium, the CCC-19 Consortium that was founded, literally, on March 15, middle of March. Many of us had questions regarding COVID-19 and cancer.
How do we evaluate the risk in these patients? Is the risk the same compared to patients with no cancer? What are the treatment characteristics and treatment patterns? How can this data impact treatment decisions in those patients? What are the outcomes?
We decided to create this consortium, CCC19, COVID-19 and Cancer Consortium, along with colleagues from other cancer centers. Dr. Jeremy Warner from Vanderbilt University is leading that effort and there are many other colleagues. There are 11 of us who have formed a steering committee. I'm honored to be part of that. There is also a number of great colleagues, 10 other colleagues, exceptional colleagues on the steering committee, helping us design the study that we do. The first data cut of this consortium is being presented at ASCO. The methodology we used was based on what we call crowdsourcing.
Pretty much, we created the survey with very granular data details that have to do with the baseline demographics with a history of cancer, cancer treatment, cancer status, other details related to the cancer history and treatment, as well as COVID-19 treatment and other characteristics as well as outcomes.
How long these patients lived, what was the outcome at one month and later, any chance of hospitalization or ICU admission, mechanical ventilation, what we call severe COVID-19 illness.
We reached out to multiple institutions. We very rapidly got immediate responses. We now have more than 100 institutions who help collect the data in US, Canada, Spain. Now we try to expand in other areas of the world. We have great collaborations with multiple investigators from United States, Canada, now, important to say that European sites are trying to collaborate as well as other sites globally to have a significant diversity in the data collection and data granularity.
Based on this data collection in these surveys with a caveat of retrospective study, we present our first data cut at ASCO 2020. Concurrently, there is a publication at "Lancet" that came out on May 28th, 2020.
There are many results. I ask the audience to read carefully the Lancet paper and see the presentation by Dr Warner at the virtual ASCO. One of the main findings was the 30-day mortality, which means the proportion of patients who died within 30 days from COVID-19 infection. It was 13 percent, one-three.
This is, you can argue, a high number, about double of what we have seen in other data sets not necessarily in patients with cancer. The first glance, the number is concerning, that cancer might be making these patients more vulnerable to mortality with COVID-19.
In addition to that, we looked at particular risk factors that can increase the risk of mortality within 30 days. Those in our multivariable analysis included older age, more senior patients have higher risk. Male sex, men versus women, have higher risk. Also, former smokers-- we know smoking is a very detrimental negative factor, not only in COVID-19, but generally.
Also, poor performance status. If patients were impaired functionally -- they had what we call ECOG 2 or higher performance status -- they were high-risk. Active cancer, the presence of cancer itself, compared to someone who's in remission, this was a risk factor. Especially those with progressing cancer even more, but even the presence of cancer was a risk factor compared to a remission.
Interestingly, of course with a huge grain of caution here, we look at different treatments for COVID-19, specifically, the combination of hydroxychloroquine and azithromycin. We found that this combination, in this particular analysis with all the caveats and confounding factors, was associated with higher 30-day mortality compared to patients who did not get the combination.
On that note, I just want to make clear that we have to take these results with a grain of salt, as we know that patients who are more sick, had more severe disease, they may have had a higher chance to receive this combination of hydroxychloroquine azithromycin.
There might be some confounding by indication or by severity of disease. It's very hard to draw significant conclusions about that particular combination. We need more data, longer follow-up, and more, I would say, events. Hopefully, we have zero events, of course. But as we all know, sadly, the COVID-19 has taken a toll.
We're going to have higher sample size, more events, so we can inform better the community and have follow-up, hopefully soon, in the next few months, based on the analysis in a larger sample size. We can see more granular data in specific tumor types, specific treatments, other characteristics of interest down the road. Stay tuned for more data to come in.
One take-home point for me though is despite this challenging situation and especially as we’re emerging through the first acute peak surge here of the COVID-19, many of us believe that if a patient needs treatment for cancer urgently, we have to go ahead and treat the patient for the cancer. That's an important take-home point.
Of course, we have to individualize and take individual patients into account, pros and cons, risks and benefits, an individual's specific level, and make informed decisions with our patients based on the particular pandemic in the specific area and patients' individual characteristics.
Overall, I would say on the most part, many of us would agree that if patient needs a treatment for cancer, it's very reasonable to proceed with a treatment for cancer, whatever that treatment is, using significant precautions of course, social distancing, masks, personal hygiene, just to reduce exposure to COVID-19 and preserve PPE.
It's important to know that cancer is still an important risk factor by itself and have claimed patients' lives. We have to treat that cancer as well, when we can. That's an important take-home message. I urge the audience to see the presentation by Dr. Warner and read the manuscript as well.
A lot of other data is being presented. This is very exciting overall, to see this virtual ASCO meeting. Of course, we all would wish that we could be in person and see each other, interact. However, I think ASCO did the right thing and protected all of us. I'm glad that and happy that we have the opportunity to still have the scientific session online.
I'm very happy to be able to see the presentations and review the data and have many online platforms and social media to discuss with colleagues. Still, it's a very positive experience and the right decision by ASCO. Thank you for having me today. I'm happy to take questions.
