Impact of Anti-angiogenic Drugs on Severity of COVID-19 in Patients with Non-Small Cell Lung Cancer

Abstract

Introduction: The 2019 coronavirus disease (COVID-19) pandemic has reshaped oncology practice, but the impact of anti-angiogenic drugs on the severity of COVID-19 in patients with non-small cell lung cancer (NSCLC) remains unclear. Patients and Methods: We carried out a retrospective study involving 166 consecutive patients with NSCLC who were positive for COVID-19, aiming to determine the effects of anti-angiogenic drugs on disease severity, as defined by severe/critical symptoms, intensive care unit (ICU) admission/intubation, and mortality outcomes. Risk factors were identified using univariate and multivariate logistic regression models. Results: Of the participants, 73 had been administered anti-angiogenic drugs (termed the anti-angiogenic therapy (AT) group), while 93 had not (non-AT group). Comparative analyses showed no significant disparity in the rates of severe/critical symptoms (21.9% vs 35.5%, P = 0.057), ICU admission/intubation (6.8% vs 7.5%, P = 0.867), or death (11.0% vs 9.7%, P = 0.787) between these two groups. However, elevated risk factors for worse outcomes included age ≥ 60 (odds ratio (OR): 2.52, 95% confidence interval (CI): 1.07-5.92), Eastern Cooperative Oncology Group performance status of 2 or higher (OR: 21.29, 95% CI: 4.98-91.01), chronic obstructive pulmonary disease (OR: 7.25, 95% CI: 1.65-31.81), hypertension (OR: 2.98, 95% CI: 1.20-7.39), and use of immunoglobulin (OR: 5.26, 95% CI: 1.06-26.25). Conclusion: Our data suggests that the use of anti-angiogenic drugs may not exacerbate COVID-19 severity in NSCLC patients, indicating their potential safe application even during the pandemic period.

Keywords: COVID-19 severity; anti-angiogenic drugs; coronavirus disease 2019; non-small cell lung cancer; risk factors.

Figure 1.

COVID-19 in patients with NSCLC. (a) Daily cases and cumulative incidence of positive SARS-CoV-2 RT-PCR and/or serology test in patients with NSCLC. (b) Patients with known information showed signs and symptoms of COVID-19 infection. Error bars show 95% CI estimates of the population proportion. (c) Patients were identified starting from the first case on December 12, 2022, to January 15, 2023, and followed until February 15, 2023. Cancer treatment, COVID-19 infection severity, and patients’ COVID-19 status at the time of final follow-up. By the end of the follow-up period, 4.2% (7/166) of patients had uncured, with one still hospitalized due to COVID-19; three patients had not returned to pre-COVID-19 clinical symptoms; and three patients had not returned to pre-COVID-19 physical condition. CI, confidence interval.

Figure 2.

Effect of anti-angiogenic drugs on survival outcomes in NSCLC patients with COVID-19. (a) Kaplan-Meier survival curve of overall survival comparing the AT group and the non-AT group. (b) Kaplan-Meier survival curve for overall survival of patients receiving anti-angiogenic drugs during COVID-19 infection versus those who did not. AT, anti-angiogenic therapy.

Figure 3.

Effect of different COVID-19 treatment drugs on mortality outcomes. Error bars show 95% CI estimates of the population proportion. *P < 0.05; **P < 0.01; ns, no significance; CI, confidence interval.

Figure 4.

Multivariable model of factors associated with COVID-19 severity (severe/critical symptoms and death). Odds ratios were calculated by multivariate regression analysis based on univariate regression analysis with P < 0.05. Error bars represent 95% CIs. The x-axis is presented on a log10 scale. CI, confidence interval.

Figure 5.

The odds ratio (OR) for severe/critical symptoms of COVID-19 was calculated based on baseline characteristics. *P < 0.05.

Figure 6.

(a-c) Proportion of severe outcomes of COVID-19 (severe/critical symptoms, ICU admission/intubation, and death) among AT and non-AT groups for different types of cancer. (d-f) Proportion of patients with and without brain metastases who developed severe outcomes of COVID-19 (severe/critical symptoms, ICU admission/intubation, and death) in the AT and non-AT groups. AT, anti-angiogenic therapy; ICU, intensive care unit.