Nearly one in five patients with malignant pleural mesothelioma (MPM) at a Barcelona hospital contracted COVID-19 during the pandemic. In addition, those patients suffered a 75% mortality rate, according to research presented today during MA04: Current Status and Future Prospects of Pleural Mesothelioma and Thymoma at the IASLC 2021 World Conference on Lung Cancer.
Malignant pleural mesothelioma is an aggressive pleural tumor associated with asbestos exposure and with limited survival despite systemic therapy.
Patients with cancer or thoracic malignancies may be particularly affected by COVID-19. The TERAVOLT registry evaluated the effect of SARS-CoV-2 infection on patients with thoracic malignancies but included only eight patients with malignant pleural mesothelioma. In a recent study of COVID-19 and mortality in the United States, malignant pleural mesothelioma was significantly associated with increased odds for worse outcomes.
To study the effect of COVID-19 infection on patients with malignant pleural mesothelioma Dr. Susana Cedres of Vall d´Hebron University Hospital and the Institute of Oncology, Barcelona, Spain, analyzed the medical records of 38 patients with malignant pleural mesothelioma. Dr. Cedres collected clinical data including demographics, comorbidities, oncological background, and COVID-19 illness status.
Of the 38 patients with malignant pleural mesothelioma at our institution in this pandemic era, seven were diagnosed with COVID-19 infection (18%) by a positive RT-PCR."
Dr. Susana Cedres, Vall d´Hebron University Hospital and Institute of Oncology, Barcelona, Spain
Clinical characteristics of the patients with COVID-19 were: median age of 62 years, four (57%) men, four (57%) patients who do not choose to smoke, and three (43%) patients who smoked in the past. All patients presented with a history of malignant pleural mesothelioma epithelioid histology. The most common comorbidities were hypertension, ischemic heart disease, and chronic obstructive disease. Four patients (57%) were taking anticoagulants or aspirin.
At the moment of COVID-19 infection, two patients were receiving oncological treatment: one patient was receiving chemotherapy and one patient was receiving thoracic radiotherapy. Regarding the clinical onset of COVID-19 infection, three patients were asymptomatic (tested due to known exposure to a patient with confirmed infection), and four patients were symptomatic with median of four days between onset of symptoms and COVID-19 diagnosis.
All symptomatic patients had fever and dyspnea. In total, six patients (85%) were hospitalized for a median stay of 12 days (3-28) of hospitalization. All patients required oxygen (three patients used a simple face mask and three patients with non-re-breather mask), and four patients developed bilateral pneumonia. Four patients had complete blood analysis, and all presented with lymphopenia, high D-dimer, and high levels of serum IL-6.
In total five patients died, four of whom died due to COVID-19 infection (54%). The median overall survival was 17.8 months from cancer diagnosis (9.3-NA) and 0.4 months (0.06-5 months) since COVID-19 diagnosis.
"From our experience, 18% of patients with malignant pleural mesothelioma were diagnosed of COVID-19 infection during the pandemic, and these patients suffered a very high mortality rate of 54 percent," Dr. Cedres said. "I urge health care services to pay particular attention to patients with malignant pleural mesothelioma while managing COVID-19 infections. "