COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study: The Lancet Oncology

M.C. Garassino, J.G. Whisenant, L.-C. Huang, A. Trama, V. Torri, F. Agustoni, J. Baena, G. Banna, R. Berardi, A.C. Bettini, E. Bria, M. Brighenti, J. Cadranel, A. De Toma, C. Chini, A. Cortellini, E. Felip, G. Finocchiaro, P. Garrido, C. GenovaR. Giusti, V. Gregorc, F. Grossi, F. Grosso, S. Intagliata, N. La Verde, S.V. Liu, J. Mazieres, E. Mercadante, O. Michielin, G. Minuti, D. Moro-Sibilot, G. Pasello, A. Passaro, V. Scotti, P. Solli, E. Stroppa, M. Tiseo, G. Viscardi, L. Voltolini, Y.-L. Wu, S. Zai, V. Pancaldi, A.-M. Dingemans, J. Van Meerbeeck, F. Barlesi, H. Wakelee, S. Peters, L. Horn, TERAVOLT investigators

Research output: Contribution to journalArticlepeer-review


Background: Early reports on patients with cancer and COVID-19 have suggested a high mortality rate compared with the general population. Patients with thoracic malignancies are thought to be particularly susceptible to COVID-19 given their older age, smoking habits, and pre-existing cardiopulmonary comorbidities, in addition to cancer treatments. We aimed to study the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on patients with thoracic malignancies. Methods: The Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry is a multicentre observational study composed of a cross-sectional component and a longitudinal cohort component. Eligibility criteria were the presence of any thoracic cancer (non-small-cell lung cancer [NSCLC], small-cell lung cancer, mesothelioma, thymic epithelial tumours, and other pulmonary neuroendocrine neoplasms) and a COVID-19 diagnosis, either laboratory confirmed with RT-PCR, suspected with symptoms and contacts, or radiologically suspected cases with lung imaging features consistent with COVID-19 pneumonia and symptoms. Patients of any age, sex, histology, or stage were considered eligible, including those in active treatment and clinical follow-up. Clinical data were extracted from medical records of consecutive patients from Jan 1, 2020, and will be collected until the end of pandemic declared by WHO. Data on demographics, oncological history and comorbidities, COVID-19 diagnosis, and course of illness and clinical outcomes were collected. Associations between demographic or clinical characteristics and outcomes were measured with odds ratios (ORs) with 95% CIs using univariable and multivariable logistic regression, with sex, age, smoking status, hypertension, and chronic obstructive pulmonary disease included in multivariable analysis. This is a preliminary analysis of the first 200 patients. The registry continues to accept new sites and patient data. Findings: Between March 26 and April 12, 2020, 200 patients with COVID-19 and thoracic cancers from eight countries were identified and included in the TERAVOLT registry; median age was 68·0 years (61·8–75·0) and the majority had an Eastern Cooperative Oncology Group performance status of 0–1 (142 [72%] of 196 patients), were current or former smokers (159 [81%] of 196), had non-small-cell lung cancer (151 [76%] of 200), and were on therapy at the time of COVID-19 diagnosis (147 [74%] of 199), with 112 (57%) of 197 on first-line treatment. 152 (76%) patients were hospitalised and 66 (33%) died. 13 (10%) of 134 patients who met criteria for ICU admission were admitted to ICU; the remaining 121 were hospitalised, but were not admitted to ICU. Univariable analyses revealed that being older than 65 years (OR 1·88, 95% 1·00–3·62), being a current or former smoker (4·24, 1·70–12·95), receiving treatment with chemotherapy alone (2·54, 1·09–6·11), and the presence of any comorbidities (2·65, 1·09–7·46) were associated with increased risk of death. However, in multivariable analysis, only smoking history (OR 3·18, 95% CI 1·11–9·06) was associated with increased risk of death. Interpretation: With an ongoing global pandemic of COVID-19, our data suggest high mortality and low admission to intensive care in patients with thoracic cancer. Whether mortality could be reduced with treatment in intensive care remains to be determined. With improved cancer therapeutic options, access to intensive care should be discussed in a multidisciplinary setting based on cancer specific mortality and patients' preference. Funding: None. © 2020 Elsevier Ltd
Original languageEnglish
Pages (from-to)914-922
Number of pages9
JournalLancet Oncol.
Issue number7
Publication statusPublished - 2020


  • adult
  • age
  • aged
  • Article
  • cancer chemotherapy
  • cancer staging
  • chronic obstructive lung disease
  • clinical feature
  • cohort analysis
  • controlled study
  • coronavirus disease 2019
  • cross-sectional study
  • disease association
  • disease registry
  • female
  • follow up
  • histopathology
  • human
  • hypertension
  • intensive care unit
  • major clinical study
  • male
  • medical history
  • medical record
  • mortality risk
  • non small cell lung cancer
  • observational study
  • pandemic
  • priority journal
  • reverse transcription polymerase chain reaction
  • sex
  • smoking habit
  • symptom
  • thorax cancer
  • virus pneumonia
  • Betacoronavirus
  • cause of death
  • clinical trial
  • Coronavirus infection
  • hospitalization
  • longitudinal study
  • middle aged
  • mortality
  • multicenter study
  • pathology
  • register
  • risk factor
  • thorax tumor
  • Aged
  • Cause of Death
  • Coronavirus Infections
  • Cross-Sectional Studies
  • Female
  • Hospitalization
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral
  • Registries
  • Risk Factors
  • Thoracic Neoplasms


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