Data from an observational study of outcomes for patients with cancer who were also diagnosed with coronavirus disease 2019 (COVID‐19) indicate a racial disparity in gaining access to the drug remdesivir as well as increased mortality associated with the steroid dexamethasone. The data form the basis of the second report on 2186 patients in the United States by the COVID‐19 and Cancer Consortium (CCC19), which has been published in Cancer Discovery.1 Consortium researchers also confirm in the report that unproven COVID‐19 therapies were broadly used outside clinical trials.
RECOVERY Trial Findings
According to the United Kingdom’s RECOVERY trial assessing the efficacy of different treatments for hospitalized patients with COVID‐19 using the end point of mortality within 28 days, which has been published in The New England Journal of Medicine, dexamethasone lowered the death rate in critically ill patients. CCC19 data, however, revealed the drug’s association with increased mortality among patients diagnosed with cancer and COVID‐19. The latter study showed that patients who received high‐dose corticosteroids with any other potential COVID‐19 treatment were twice as likely to die as the patients who either were treated with other medications or did not require any treatment. The number of patients treated solely with steroids was small, and this made it difficult for investigators to analyze steroid treatment alone.
Corresponding author Jeremy L. Warner, MD, MS, associate professor of medicine and biomedical informatics at Vanderbilt University, notes that because cancer is already an immunocompromising disease, dexamethasone potentially could worsen patients’ conditions. He adds that the RECOVERY trial results did not provide details about cancer patient subgroups.
Meanwhile, remdesivir, primarily used in a clinical trial setting, was associated in the RECOVERY trial results with a lower mortality rate in comparison with any other potential COVID‐19 treatment; however, Black patients were half as likely as White patients to receive it. Dr. Warner notes that Black patients were likely underrepresented for nonclinical factors. These findings call attention to a pressing need to address these disparities because Black patients and other people of color have been much more heavily affected by the pandemic.
Initial CCC19 Study Findings
In the initial CCC19 study of 928 patients, the mortality rate for patients with cancer who were also diagnosed with COVID‐19 was 13%. In this second study of 2186 patients, the rate was 16%. Additional findings showed that West Coast patients were more likely to have received remdesivir and less likely to have taken hydroxychloroquine, which has been demonstrated to be ineffective and associated with higher mortality. A potential reason was that the greater number of cases on the West Coast provided clinicians with more information about the risks and benefits of both drugs.