During the global COVID-19 pandemic, the scientific community is racing to develop vaccine candidates, evaluate new drugs, and study existing drugs for repurposing. There is a particular need to find ways to treat COVID-19 in cancer patients, for whom the virus can have particularly severe consequences.
A large observational study published recently in Cancer Discovery looked at the association of COVID-19 treatments with 30-day all-cause mortality, as well as sociodemographic factors associated with treatment. The study was conducted by the COVID-19 and Cancer Consortium (CCC19). The grassroots consortium of more than 120 cancer centers, including the Herbert Irving Comprehensive Cancer Center (HICCC) at NewYork-Presbyterian/Columbia, and other organizations was formed to collect data as rapidly as possible on cancer patients who have been diagnosed with COVID-19.
The study, “Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: A COVID-19 and Cancer Consortium (CCC19) cohort study,” confirmed that cancer patients who were infected with COVID-19 died at a significantly higher rate (16%) than the general population (2–7%). This is three times the global average and higher than the 13% reported in a study published in Lancet in May 2020.
Overall, the CCC19 study found no statistically significant benefit from treatment with hydroxychloroquine or high-dose systemic corticosteroids, either alone or in combination. However, the study did find an increased death rate in cancer patients treated with hydroxychloroquine in combination with any other drug (usually azithromycin).
The only treatment that showed any benefit was the antiviral drug remdesivir. Though remdesivir showed a reduced death rate compared with untreated controls, the difference was not statistically significant.
Jessica Hawley, MD, assistant professor of medicine at Columbia’s Vagelos College of Physicians and Surgeons and a member of the Genitourinary (GU) Group in the Division of Hematology and Oncology, represents the HICCC in the consortium. “In treating cancer,” says Dr. Hawley, “oncologists adhere to the gold standard of using data from randomized, controlled trials. During the urgency of a global pandemic, however, observational studies—when conducted and analyzed well—can offer valid answers to clinical questions in the absence of clinical trials. Findings from the observational studies inform the selection of treatments on which to conduct clinical trials.”
The study looked at 2,186 adults with invasive cancer and laboratory-confirmed COVID-19 infection; 40% of them received some form of COVID-19 treatment. The median age of the patients was 67; 49% were male, 51% were non-Hispanic white, and 46% lived in the Northeast US. In addition, 51% of the patients were in remission from cancer; 28% had cancer that was stable or responding to treatment; and 11% had actively progressing cancer.
The COVID-19 treatments studied were hydroxychloroquine, azithromycin, remdesivir, high-dose corticosteroids, tocilizumab, and other therapies, both alone and in combination. Treatments received by the study population were administered almost entirely outside of clinical trials. The exception was remdesivir; 69% of patients receiving remdesivir did so as part of a clinical trial. Though some patients may have received other treatments prior to receiving remdesivir, while enrolled in a clinical trial, they received only remdesivir.
The study examined sociodemographic factors associated with receiving any COVID-19 treatment, a combination of hydroxychloroquine and azithromycin, or remdesivir. Black patients were found to be half as likely as white patients to receive remdesivir, which is less easily available and more expensive. (Patients living in the Western US were more likely to receive remdesivir, which may reflect the fact that the West was affected by the pandemic later, when physicians had more experience treating COVID and early results of the remdesivir trial had been released.)
Gary Schwartz, MD, is deputy director of the HICCC and division chief of hematology/oncology in the Department of Medicine at Columbia University Irving Medical Center. What he finds most striking about the study is how it underlines the racial disparities in access to potentially effective treatments.
“It is our responsibility,” says Dr. Schwartz, “to increase the access of underserved populations both to clinical trials and to effective drugs. In particular, it is critical that the Black population be involved in clinical trials for a COVID-19 vaccine.”
The HICCC is a Minority and Underserved designated site for the National Cancer Institute’s Community Oncology Research Program (NCORP). Says Schwartz, who is one of the HICCC’s principal investigators for NCORP, “the Cancer Discovery paper reinforces the need for us to improve the access of vulnerable populations in the CUIMC/NYP neighborhood to clinical trials.”
-Ann Rae Jonas