medwireNews: Results from the COVID-19 and Cancer Consortium (CCC19) show that a variety of treatments for COVID-19 have no significant positive impact on 30-day mortality in patients with invasive cancer.
The researchers note that treatment with the antiviral remdesivir, which has been used to treat SARS-CoV-2 infection, reduced the mortality risk, but this was not statistically significant relative to patients who received no investigational COVID-19 treatments.
By contrast, hydroxychloroquine – an antimalarial drug being used to treat some patients with COVID-19 – seemed to increase the risk for mortality when combined with other drug treatments in these patients.
Overall, 2186 patients from CCC19 were included in the analysis, published in Cancer Discovery, which assessed whether any drugs for COVID-19 impacted 30-day survival in patients with a laboratory-confirmed diagnosis of the virus. The median age of the participants was 67 years, and just over half (51%) were in remission from cancer, while 28% had treatment-responsive or stable disease and 11% had progressive disease.
Among the 865 patients who received one or more of the COVID-19 treatments of interest, the most commonly used regimen was hydroxychloroquine plus azithromycin (23%), followed by single-agent hydroxychloroquine (21%), azithromycin (18%), and remdesivir (7%).
Jeremy Warner (Vanderbilt University Medical Center, Nashville, Tennessee, USA) and fellow investigators found that individuals who received hydroxychloroquine alongside any other agent had a significantly increased 30-day mortality risk, with propensity score-matched adjusted odds ratios (ORs) of 1.99 versus those who received any other investigational treatment for COVID-19 (positive controls) and 2.15 versus those who received no such treatment (negative controls).
Treatment with hydroxychloroquine alone did not significantly increase the mortality risk, but neither did it reduce the risk.
High-dose corticosteroids, such as dexamethasone, together with any other agent were similarly significantly associated with an elevated mortality risk relative to positive and negative controls, with ORs of 2.04 and 3.16, respectively, after adjusting for factors such as comorbidities, cancer status, and baseline COVID-19 severity. And the mortality risk was numerically higher with corticosteroid monotherapy versus no treatment.
“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 Warner in a press statement.
“This does have some rational explanation, since cancer is already an immunocompromised state and steroids could potentially make things worse.”
The one potentially positive signal was observed with remdesivir, which was associated with a significant decreased mortality risk versus the positive controls, at an adjusted OR of 0.41, but not versus the negative controls.
Warner and colleagues comment that these results are “consistent with literature suggesting that the drug may lessen disease severity or reduce the duration of infection, similar to currently approved antivirals for other conditions.”
They note, however, that Black patients were half as likely to be treated with remdesivir compared with White patients.
The researchers caution that their study was observational and highlight the potential for selection bias and confounding by COVID-19 severity, “as patients with increased baseline severity were more likely to be treated with one or more therapies.”
And they conclude: “We encourage the evaluation of these treatments in prospective [randomized controlled trials], along with systematic efforts to assess and address disparities and promote health equity in current studies evaluating potentially effective anti-COVID-19 therapies.”
By Helen Albert
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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