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COVID-19 and cancers of the chest cavity make a deadly combination, researchers .

The mortality rate for patients with thoracic cancer and COVID-19 was 35.5%, said Leora Horn, MD, of Vanderbilt University Medical Center in Nashville.

Of the 428 patients diagnosed with thoracic cancer and also infected with COVID-19, Horn said 169 have recovered, 119 have ongoing COVID-19 infection, and 141 died.

Among those deaths, 79.4% were attributed to COVID-19 and 10.6% to the patients' progressive cancer, she reported. Another 8.5% died of a combination of cancer and COVID-19. Just 8.3% of the patients were admitted to an intensive care unit; 5% of the patients who died utilized ventilators.

Horn said 78% of patients with the combination of COVID-19 and thoracic cancer were admitted to the hospital.

Howard Burris III, MD, president of ASCO, commented, "A number of factors -- pre-existing lung damage, smoking status, advanced age, and comorbidities -- make patients with thoracic cancers especially vulnerable to COVID-19. There are a lot of questions right now, and not a lot of answers. These findings give us some insights into outcomes for patients with cancer who develop COVID-19."

Horn was reporting updated results of the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry. "Patients with thoracic malignancies are considered high risk given their age, pre-existing comorbidities, smoking, and pre-existing lung damage in addition to therapies administered to treat their illness. We launched a global consortium to collect data on patients with thoracic malignancies diagnosed with COVID-19 infection to understand the impact on this patient population," she said.

Earlier results from TERAVOLT were presented at the American Association for Cancer Research meeting when 200 patients had been entered into the registry. At that time most of the patients were European. Overall mortality was 33.3%, and COVID-related complications were the cause in 89%. The current update includes more American patients. The earlier results had a 15-day median follow-up; the current results have a 33-day median follow-up, Horn said.

In the current analysis, median age of recovered patients was 63.3; it was a year older for those still being treated. Median age of patients with fatal cases was 70.2.

Most TERAVOLT patients were male, and a small percentage were never smokers. Most patients had ECOG performance status of 0-1. The majority had non-small cell lung cancer, and 60% to 75% of patients had stage IV disease. Lung cancer was the most common diagnosis but the study also included other thoracic malignancies such as mesothelioma, thymic neoplasms, and carcinoid tumors.

Risk factors for mortality were:

• Age greater than 65
• Presence of comorbidities
• ECOG performance status greater than 1
• Administration of steroids greater than 10 mg/day and anticoagulant use prior to COVID-19 infection
• Prior administration of chemotherapy within 3 months of COVID infection

Immunotherapy and tyrosine kinase inhibitors were not risk factors, Horn said. She also noted that therapies to treat COVID-19 did not appear to affect outcomes.

"Data collection is ongoing with additional analysis planned to look at patient and provider perception of COVID-19 impact on cancer care," Horn said.