Study Shows Disparities, Effects of Treatment for Patients With Cancer and COVID-19

Data from a treatment utilization study revealed racial disparities in treatments as well as the effects and clinical outcomes of treatments such as remdesivir (Veklury) and dexamethasone in patients with cancer who were diagnosed with coronavirus disease 2019 (COVID-19).^1,2

On July 22, the COVID-19 and Cancer Consortium published data on therapies given to improve COVID-19 outcomes in 2186 patients with cancer. This cancer-specific observational study is the largest to be published so far and looked at the use of unproven therapies for treating people with COVID-19; most of these were outside of clinical trials.

Patients given high-dose corticosteroids or hydroxychloroquine (Plaquenil) alone or in combination had no statistically significant 30-day all-cause mortality benefit. However, those receiving remdesivir exhibited potential benefit.

This study found an association with increased mortality with dexamethasone for patients with cancer and COVID-19, in contrast to previous published data. According to the RECOVERY trial, dexamethasone lowered death rates for patients who were critically ill.³

“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,” Jeremy Warner, MD, MS, associate professor Medicine and Biomedical Informatics at Vanderbilt University and the study’s corresponding author, said in a statement. “This does have some rational explanation, since cancer is already an immunocompromised state and steroids could potentially make things worse. The RECOVERY trial is the first to show a survival benefit for any treatment of COVID-19, but that study just published in The New England Journal of Medicine does not provide details for the subgroup of patients with cancer.”¹

A decreased probability for Black patients to receive treatment with remdesivir, which was associated with a lower mortality rate compared to other options used to potentially treat COVID-19, was also seen in the study. These patients were half as likely to be given this agent compared to white patients.²

“Our study reinforces the finding that most COVID-19 treatment occurs outside the context of a formal clinical trial,” Warner said in a press release. “The exception to this was the drug remdesivir, which was given mostly through the clinical trial setting. It appears that Black patients were underrepresented in the clinical trials of remdesivir, likely due to reasons other than purely clinical factors. The unfortunate conclusion is that racial disparities in access to clinical trials continue to exist, and one of our recommendations is that the necessary steps to address such disparities need to be accelerated, especially given that Black patients and other people of color appear to be taking the brunt of the COVID-19 pandemic.”

There was mild baseline severity of COVID-19 in 1037 (47%) patients observed in the study, it was moderate in 876 (40%) patients, and severe in 273 (12%) patients. There was no treatment was reported for 1321 (60%) patients. Hydroxychloroquine was given in 538 (25%) patients, azithromycin in 485 (22%), remdesivir in 124 (6%), high-dose corticosteroids in 109 (5%), tocilizumab (Actemra) in 94 (4%), and other therapy in 90 (4%); these treatments were given as a combination or monotherapy.

_References:

_{1. New data offer insights on COVID treatments for people with cancer [press release]. Vanderbilt University Medical Center. Published July 22, 2020. Accessed July 23, 2020. https://bit.ly/3eXoUuF}

_{2. Rivera DR, Peters S, Panagiotou OA, et al. Utilization of COVID-19 treatments and clinical outcomes among patients with cancer: A COVID-19 and Cancer Consortium (CCC19) cohort study. Cancer Discov. Published OnlineFirst July 22, 2020. doi:10.1158/2159-8290.CD-20-0941}

_{3. Horby P, Lim WS, Emberson JR, et al; the RECOVERY collaborative group. Dexamethasone in hospitalized patients with COVID-19—preliminary report. N Engl J Med. Published June 17, 2020. doi:10.1056/NEJM2021436}