Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
Kuderer et al.
, Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
, Lancet, June 20, 2020, doi:10.1016/S0140-6736(20)31187-9 (date from earlier preprint)
Retrospective 928 cancer patients, showing HCQ OR 1.06 [0.51-2.20]. HCQ+AZ OR 2.93 [1.79-4.79]. The relative risks of different therapies suggest that the results are overly affected by confounding by indication
. Authors note: HCQ+AZ might not be the cause of increased mortality, but instead these were given to patients with more severe COVID-19.
This study is excluded in the after exclusion results of meta
substantial unadjusted confounding by indication
risk of death, 134.2% higher, RR 2.34, p < 0.001, treatment 45 of 181 (24.9%), control 76 of 747 (10.2%), odds ratio converted to relative risk, HCQ+AZ.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kuderer et al., 28 May 2020, retrospective, USA, peer-reviewed, 73 authors.
Clinical impact of COVID-19 on patients with cancer (CCC19):
a cohort study
Nicole M Kuderer*, Toni K Choueiri*, Dimpy P Shah*, Yu Shyr*, Samuel M Rubinstein, Donna R Rivera, Sanjay Shete, Chih-Yuan Hsu,
Aakash Desai, Gilberto de Lima Lopes Jr, Petros Grivas, Corrie A Painter, Solange Peters, Michael A Thompson, Ziad Bakouny, Gerald Batist,
Tanios Bekaii-Saab, Mehmet A Bilen, Nathaniel Bouganim, Mateo Bover Larroya, Daniel Castellano, Salvatore A Del Prete, Deborah B Doroshow,
Pamela C Egan, Arielle Elkrief, Dimitrios Farmakiotis, Daniel Flora, Matthew D Galsky, Michael J Glover, Elizabeth A Griffiths, Anthony P Gulati,
Shilpa Gupta, Navid Hafez, Thorvardur R Halfdanarson, Jessica E Hawley, Emily Hsu, Anup Kasi, Ali R Khaki, Christopher A Lemmon, Colleen Lewis,
Barbara Logan, Tyler Masters, Rana R McKay, Ruben A Mesa, Alicia K Morgans, Mary F Mulcahy, Orestis A Panagiotou, Prakash Peddi,
Nathan A Pennell, Kerry Reynolds, Lane R Rosen, Rachel Rosovsky, Mary Salazar, Andrew Schmidt, Sumit A Shah, Justin A Shaya, John Steinharter,
Keith E Stockerl-Goldstein, Suki Subbiah, Donald C Vinh, Firas H Wehbe, Lisa B Weissmann, Julie Tsu-Yu Wu, Elizabeth Wulff-Burchfield,
Zhuoer Xie, Albert Yeh, Peter P Yu, Alice Y Zhou, Leyre Zubiri, Sanjay Mishra, Gary H Lyman*, Brian I Rini*, Jeremy L Warner*, on behalf of
the COVID-19 and Cancer Consortium
Background Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of
a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.
Methods In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged
18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the
USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were
added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer
diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days
of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using
logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with
ClinicalTrials.gov, NCT04354701, and is ongoing.
Findings Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria
for our analysis. Median age was 66 years (IQR 57–76), 279 (30%) were aged 75 years or older, and 468 (50%) patients
were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were
on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020),
121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day
mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI
1·53–2·21), male sex (1·63, 1·07–2·48), smoking status (former smoker vs never smoked: 1·60, 1·03–2·47), number
of comorbidities (two vs none: 4·50, 1·33–15·28), Eastern Cooperative Oncology Group performance status of 2 or
higher (status of 2 vs 0 or 1: 3·89, 2·11–7·18), active cancer (progressing vs remission: 5·20, 2·77–9·77), and receipt
is less effective
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