Outcomes of COVID-19 Patients under Cytotoxic Cancer Chemotherapy in Brazil

Simple Summary Cancer patients present a distinct vulnerability to COVID-19. It is unclear if chemotherapy per se increases the overall risk in this population. In our study, we analyzed retrospective COVID-19 data linked to oncological information systems to evaluate outcomes in COVID-19 cancer patients under chemotherapy. We identified 681 patients with a past history of chemotherapy. Patients in active chemotherapy did not have an increased mortality compared to non-active chemotherapy COVID-19 cases. We identified the use of topoisomerase II inhibitors and alkylating agents as protective factors, while palliative intent of treatment and hematological neoplasms were risk factors. Background: Cancer patients present a distinct vulnerability to COVID-19. It is unclear if chemotherapy could accentuate the overall risk in these patients. Methods: We performed a retrospective analysis linking COVID-19 data and oncological information systems to compare lethality in patients undergoing cytotoxic chemotherapy before COVID-19. We considered patients who received chemotherapy in the last 30 days as in "active treatment", and patients who did not receive drugs in this period as "non-active treatment" for propensity-score pair matching. We also tested the influence of baseline variables in our results in a multivariate model. Results: 66.1% (162/246) of patients in matched active chemotherapy died vs. 70.2% (172/246) in the matched non-active chemotherapy group. The risk of death was positively associated with palliative intent of treatment and hematologic neoplasms. Being in active chemotherapy was not associated with increased mortality compared to non-active treatment. We also noted in exploratory propensity-score matchings that the use of alkylating agents (odds ratio [OR] 0.38, 95% confidence interval [CI], 0.21-0.70) and topoisomerase II inhibitors (OR 0.28, 95% CI 0.14-0.56) were protective factors. Conclusions: This study does not demonstrate an increase in mortality for cancer patients under active cytotoxic chemotherapy with COVID-19.