New research has shed much-needed light on the nature of SARS-CoV-2 infection among women with advanced breast cancer.
The international, multi-center investigation of more than 2,500 patients concluded that nearly half of the patients with breast cancer required hospitalization during their COVID-19 disease course, and demonstrated a 30-day all-cause mortality of 9%.
Presenting at the 2020 San Antonio Breast Cancer Symposium (abstract PS7-01), the researchers explained that the goal of the trial was to fill a void in the current breast cancer literature. “Overall,” the authors wrote, “patients with cancer experience a greater risk of adverse outcomes following SARS-CoV-2 infection; however, little is known for those with breast cancer.”
To help address this knowledge gap, they embarked on the so-called CCC19 trial (NCT04354701). The trial’s aim was to investigate the impact of COVID-19 on patients with either a history of breast cancer or active breast cancer using de-identified data on patient demographics, cancer history, clinical course, and COVID-19 outcomes. The study’s two primary outcomes were hospitalization during COVID-19 illness and 30-day all-cause mortality.
According to lead author Ali Raza Khaki, MD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington, the analysis comprised 2,683 patients from the US and Canada with cancer and laboratory-confirmed SARS-CoV-2 presenting between March 17 and July 2, 2020. Of these, 529 (20%) had invasive breast cancer.
In examining the demographic profile of the breast cancer patients, the researchers found that 352 (67%) were at least 60 years of age; 518 (98%) were women; 275 (52%) were non-Hispanic White, 116 (22%) were non-Hispanic Black; 70 (13%) were Hispanic; 178 (34%) had a history of smoking. Moreover, 75 patients (14%) had an ECOG performance status ≥2; 191 (36%) had at least two active comorbidities; 64 (12%) had AJCC stage IV disease at breast cancer diagnosis; and 267 (50%) were on anti-cancer treatment within three months of COVID-19 diagnosis, including systemic therapy, radiation, or surgery.
The analysis found that at least 323 breast cancer patients (61%) had 30-day follow-up after their COVID-19 diagnosis, while 35 (7%) had 90-day follow-up. Upon initial diagnosis, COVID-19 illness required outpatient care in 288 patients (54%), inpatient care in 193 patients (36%), and ICU care in 40 patients (8%).
Of the 529 patients with invasive breast cancer, 247 (47%) were hospitalized. Thirty-day all-cause mortality was 9%.
The researchers also assessed 30-day all-cause mortality rates according to receipt of major breast cancer treatment modalities within the previous three months, which was 10% for women on cytotoxic systemic therapy, 5% for those on noncytotoxic systemic therapy, and 12% for those on local therapy.
As the researchers noted, the investigation represents the largest study to date of COVID-19 outcomes in patients with invasive breast cancer.
“Nearly half of the patients with breast cancer required hospitalization during their COVID-19 disease course, and we observed a 9% 30-day all-cause mortality,” the authors concluded.
The abstract was submitted on behalf of the COVID-19 and Cancer Consortium (ccc19.org)
