Disparities in outcomes between Black and White patients in North America with thoracic malignancies and COVID-19 infection (TERAVOLT)

BACKGROUND

Patients with thoracic malignancies who develop COVID-19 infection have a higher hospitalization rate compared to the general population and to those with other cancer types, but how this outcome differs by race and ethnicity is relatively understudied.

METHODS

The TERAVOLT database is an international, multi-center repository of cross-sectional and longitudinal data studying the impact of COVID-19 on individuals with thoracic malignancies. Patients from North America with thoracic malignancies and confirmed COVID-19 infection were included for this analysis of racial and ethnic disparities. Patients with missing race data or races and ethnicities with fewer than 50 patients were excluded from analysis. Multivariable analyses for endpoints of hospitalization and death were performed on these 471 patients.

RESULTS

Of the 471 patients, 73% were White and 27% were Black. The majority (90%) were non-Hispanic ethnicity, 5% were Hispanic, and 4% were missing ethnicity data. Black patients were more likely to have an Eastern Cooperative Oncology Group (ECOG) Performance Status ≥ 2 (p-value = 0.04). On multivariable analysis, Black patients were more likely than White patients to require hospitalization (Odds Ratio (OR): 1.69, 95% CI: 1.01-2.83, p-value = 0.044). These differences remained across different waves of the pandemic. However, no statistically significant difference in mortality was found between Black and White patients (OR 1.29, 95% CI: 0.69-2.40, p-value = 0.408).

CONCLUSIONS

Black patients with thoracic malignancies who acquire COVID-19 infection are at a significantly higher risk of hospitalization compared to White patients, but there is no significant difference in mortality. The underlying drivers of racial disparity among patients with thoracic malignancies and COVID-19 infection require ongoing investigation.

Pemetrexed in the treatment of thoracic malignancies: a single centre experience in Singapore

INTRODUCTION

This study aimed to examine the efficacy and toxicity of pemetrexed in Singapore.

METHODS

We conducted a retrospective review of patients treated with pemetrexed between July 2005 and November 2007. RECIST was used to assess the efficacy independent of the treating physician's assessment, and NCI CTC-AE version 3.0 was used to describe adverse events.

RESULTS

37 patients had non-small-cell lung cancer (NSCLC) and six had malignant pleural mesothelioma. Those with NSCLC had a median age of 60 and an ECOG PS of 0-1, and they were predominantly male, ethnic Chinese and smokers. A median of two cycles were delivered (total 95; range 1-12). Grade 3/4 toxicity was rare. Five (14 percent) patients had an objective response (one complete, four partial) and 13 (35 percent) had stable disease. Median time to treatment failure was 1.86 months (95% confidence interval [CI] 0-6.5). Median overall survival was 18.6 months (95% CI 12.6-27.7). Median age of patients with mesothelioma was 46.5 (range 29-73) years. Five men and one woman received a median of four (total 30, range 1-15) cycles of pemetrexed in combination with cisplatin. Three patients had a partial response, two had stable disease and one had disease progression. Grade 3/4 toxicities were as follows: leucopenia, neutropenia and thrombocytopenia in one patient.

CONCLUSION

The results of this retrospective study and literature review show that pemetrexed is safe and efficacious in the treatment of Asian patients with NSCLC and mesothelioma.