High COVID Complication Rates in Sarcoma Patients

Patients with sarcoma, particularly those with high-risk factors, were likely to develop complications from COVID-19, a registry-based retrospective study found.

Of the patients included in the study, 49% were hospitalized with COVID-19, with 9% dying within 30 days of diagnosis, reported Michael Wagner, MD, of the University of Washington and Seattle Cancer Care Alliance, during the virtual Connective Tissue Oncology Society annual meeting.

In addition, a third of these patients received supplemental oxygen, 12% were admitted to the ICU, and 6% received mechanical ventilation. With additional follow-up, 16% had died of any cause.

Wagner pointed out that sarcoma patients are vulnerable to COVID-19. “Sarcomas are rare cancers, and because of the importance of tertiary care centers, patients often have to travel very long distances to seek opinions or to receive care,” he noted. “Many of the treatments they get are highly immunosuppressive, which in studies have been associated with adverse outcomes in patients with cancer and COVID-19.”

On multivariable analysis, the authors determined that the factors most associated with poor outcomes included:

• Eastern Cooperative Oncology Group (ECOG) performance status (≥2 vs 0): adjusted odds ratio (aOR) 17.28 (95% CI 5.91-50.56)
• Metastatic cancer to the lung vs no metastatic cancer: aOR 7.65 (95% CI 3.06-19.12)
• Other metastatic cancer vs no metastatic cancer: aOR 4.28 (95% 1.87-9.78)
• Pre-existing renal disease: aOR 3.33 (95% CI 1.07-10.37)
• Male sex: OR 2.13 (95% CI 1.14-4.01)

Interestingly, said Wagner, although cancer therapy in the prior 3 months was associated with worse outcomes in unadjusted analysis (OR 3.30, 95% CI 1.83-5.95), it was not in the adjusted model.

The authors used data from the COVID-19 and Cancer Consortium (CCC19), including demographics, histologic type, treatments, and course of COVID infection. Their analysis included 222 adult patients with sarcoma and laboratory-confirmed SARS-CoV-2 from March 17, 2020 to April 23, 2021.

Median age was 56 years, 52% were men, and 13% had an ECOG performance status of 2 or greater. Median follow-up from COVID-19 diagnosis was 56 days.

The primary outcome was an ordinal outcome of COVID severity, including hospitalization with or without oxygen use, ICU admission, mechanical ventilation, and all-cause death.

The included patients, of whom 54% had active cancer, were grouped by sarcoma subtype: 126 patients had soft tissue sarcoma, 40 had bone sarcomas, 36 had gastrointestinal stromal tumors, and 20 had other more indolent histologies. Within 3 months of COVID diagnosis, 31% of patients had received cytotoxic therapy, and 17% had received targeted therapy with tyrosine kinase inhibitors.

Of the patients who were hospitalized with COVID, breakdown by subtype was roughly even. There were minimal differences between sarcoma subtypes for the primary outcome, with the same holding true for different systemic therapies, Wagner said.

“There are many patients still being added to the CCC19 database,” he noted, adding that their study does not account for any impact of vaccination status, as well as the Delta variant wave that recently ran through the U.S.