Accelerated tumor progression after COVID-19 infection in patients with glioblastoma: a retrospective case-control study

We observed rapid tumor progression following COVID-19 infection among patients with glioblastoma and sought to systematically characterize their disease course in a retrospective case-control study. Using an institutional database, we retrospectively identified a series of COVID-19–positive glioblastoma cases and matched them by age and sex 1:2 to glioblastoma controls who had a negative COVID-19 test during their disease course. Demographic and clinical data were analyzed. Hyperprogression was defined using modified RECIST criteria. Time to progression and overall survival were estimated using the Kaplan-Meier method. Thirty-two glioblastoma cases with positive COVID-19 testing were matched to 64 glioblastoma controls with negative testing; age, sex, and molecular profiles did not differ between groups. Progression events occurred in 27 cases (84%) and 46 controls (72%). Of these, 14 cases (52%) presented with multifocal disease or leptomeningeal disease at progression compared with 10 controls (22%; p=0·0082). Hyperprogression was identified in 13 cases (48%) but only 4 controls (9%; p=0·0001). Cases had disease progression at a median of 35 days following COVID-19 testing, compared with 164 days for controls (p=0·0001). Median survival from COVID-19 testing until death was 8·3 months for cases but 17 months for controls (p=0·0016). Median overall survival from glioblastoma diagnosis was 20·7 months for cases and 24·6 months for controls (p=0·672). Patients with glioblastoma may have accelerated disease progression in the first 2 months after COVID-19 infection. Infected patients should be monitored vigilantly. Future investigations should explore tumor-immune microenvironment changes linking tumor progression and COVID-19.