GI cancer patients could continue therapy during COVID-19 pandemic

Results of a single-centre study in the UK have suggested that patients receiving systemic anticancer therapy for gastrointestinal (GI) cancers could continue their treatment during the COVID-19 pandemic.

There was a low rate of COVID-19 infection in GI cancer patients receiving systemic anticancer therapy, presented Dr Eirini Tsotra from Guy’s Cancer Centre, London, UK, at ASCO GI 2021.

While the mortality rate of 21.4 percent among COVID-19–positive patients was five times that of the COVID-19–negative group (3.7 percent), the rate was comparable to that of all oncology patients at the centre (21 percent), including patients not receiving immunosuppressive therapy, she said.

Participants were 417 adults with GI solid tumours who were receiving systemic anticancer therapy at Guy’s Cancer Centre between March and May 2020. The most common type of cancer was colorectal (47.0 percent) followed by oesophageal/gastric cancer (27.6 percent), hepato-pancreatic-biliary cancer (18.2 percent), and neuroendocrine tumours (7.2 percent). Most patients (70.3 percent) had stage IV cancer and 22.1 percent had stage III cancer. [ASCO GI 2021, abstract 455]

About two-thirds of patients (66.2 percent) were receiving palliative therapy, while 12.7, 17.3, and 3.8 percent were receiving neoadjuvant, adjuvant, and radical/curative therapy, respectively. Treatment was primarily chemotherapy with or without targeted or biological therapies (82.7 percent). About 16 percent of patients were receiving targeted or biological therapies only, while just four patients (1 percent) were on immunotherapy.

Fourteen patients (3.4 percent) tested positive for COVID-19, as confirmed by RT-PCR swab test. There was a greater proportion of males in the COVID-19–positive than COVID-19–negative group (64.3 percent vs 57.3 percent), as well as patients of Black African/Caribbean/Other ethnicity (21.3 percent vs 7.2 percent), or those from a low socioeconomic background (85.7 percent vs 79.7 percent). However, the mean age of those with COVID-19 was lower than those without COVID-19 (57.7 vs 63.1 years).

In the COVID-19–positive group, 57.1 percent (n=8) had colorectal cancer, while 14.3, 21.4, and 7.1 percent (n=2, 3, and 1) had oesophageal/gastric cancer, hepato-pancreatic-biliary cancer, and neuroendocrine tumours, respectively. Patients mostly had stage IV disease (57.1 percent), while 14.3 and 28.6 percent had stage II and III disease, respectively.

About 57 percent (n=8) were receiving palliative care, while 28.6 and 14.3 percent were receiving neoadjuvant and adjuvant treatment, respectively. All but one of the 14 patients with COVID-19 was receiving chemotherapy, with one patient receiving targeted or biological therapies.

Among patients with COVID-19, eight had severe disease (severe pneumonia) or critical disease (sepsis, septic shock, or acute respiratory distress syndrome), while six had mild or moderate disease (uncomplicated infection or pneumonia). None of the patients with mild or moderate disease died, while there were three deaths among patients with severe or critical disease, all of which were deemed related to COVID-19 and occurred in males on palliative therapy.

There were 15 deaths among the 403 patients without COVID-19, with a mortality rate of 3.7 percent compared with 21.4 percent among those with COVID-19.

“Limited early data suggested that cancer patients and those receiving systemic anticancer treatment were at an increased risk of COVID-19 severe infection and death,” mentioned Tsotra.

“This prospective data, from a large UK comprehensive cancer centre, provides some evidence that continuing systemic anticancer treatment through the pandemic is relatively safe,” she continued.

“Based on the above data, we could conclude that the risk of COVID-19-related infection and death must be offset against the cancer-related morbidity and mortality associated with treatment delays,” she said.