COVID-19 May Accelerate Tumor Progression in Cancer Patients

SARS-CoV-2 infection in cancer patients was associated with sustained increases in cytokines, chemokines and growth factors involved in new blood vessel formation, compared with patients who had not had this infection. In this Belgian study, serial blood samples were collected from cancer patients and analyzed.

Why Does This Study Matter?

Driven by cytokines, chemokines and growth factors (CCGFs), cancer-associated inflammation has been shown to play an important role in the progression of both solid (organ) and hematological cancers, including cancer-cell proliferation and survival, angiogenesis (new blood vessel formation) and metastasis.

The current findings may help explain the poorer outcomes observed after SARS-CoV-2 infection, particularly in people with hematological cancers (originating in blood and bone marrow).

Study Design

Outpatients scheduled for routine blood tests during the COVID-19 pandemic, including 52 cancer patients exposed to SARS-CoV-2 and 54 unexposed cancer patients, were studied together with healthcare workers from their oncology units: 15 who had contracted Covid and 42 who had not.

All participants underwent serial immunological tests for cytokines, chemokines and growth factors (CCGFs) in blood samples assessed by healthcare workers at baseline and after 1, 2 and 3 months. Clinical data were collected, including maximum disease severity on the World Health Organization COVID-19 ordinal scale.

Patients were divided into solid cancers (36 coronavirus-exposed and 32 unexposed patients) and hematological cancers (16 exposed and 22 unexposed patients). Changes in CCGF concentrations over time were determined.

Notable Results

• Unexposed cancer patients were found to have increased CCGF levels compared with unexposed healthcare workers, with no significant difference between solid and hematological cancer patients.
• Among the 19 CCGFs common to both cancer types were cytokines such as IL-6, TNF-alpha, IL-1Ra, IL-17A and VEGF, and less well-characterized cytokines and chemokines such as Fractalkine, Tie-2 and the T-cell chemokine CTACK.
• Cancer patients exposed to SARS-CoV-2 were found to have seven additional types of CCGFs significantly elevated compared with healthcare workers. Of these, TNF-alpha, IFN-beta, TSLP and sVCAM-1, which were elevated in patients with hematological cancers, are known tumor-promoting factors.
• The 3-month longitudinal analysis revealed that CCGFs such as TNF-alpha, IL-2 and MCP-3 remained elevated in coronavirus-exposed cancer patients, but not in healthcare workers. IL-2 and MCP-3 levels were found to be transiently elevated during follow-up in patients with hematological cancer.

Study Limitations

The authors highlight several limitations, including that this was a case-control study and that a prospective study in cancer patients exposed to coronavirus was not possible.

They note an imbalance in baseline characteristics between cancer patients and healthcare workers, and that cancer patients transferred to inpatient COVID-19 wards were not included.

Conclusion

We already knew that Covid-19 itself brings many adverse outcomes for cancer patients. This study sheds light on the mechanisms through which Covid-19 causes these adverse outcomes in cancer patients. Cancer patients are therefore a group that should receive vaccination priority and be protected from Covid. On the occasion of this study, let us again remind all our patients for whom vaccination has been made available by the Republic of Turkey Ministry of Health that they should receive their booster doses.

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