Clinical impact of COVID-19 on patients with cancer treated with immune checkpoint inhibition.

Abstract

BACKGROUND:

Patients with cancer who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to develop severe illness and die compared with those without cancer. The impact of immune checkpoint inhibition (ICI) on the severity of COVID-19 illness is unknown. The aim of this study was to investigate whether ICI confers an additional risk for severe COVID-19 in patients with cancer.

METHODS:

We analyzed data from 110 patients with laboratory-confirmed SARS-CoV-2 while on treatment with ICI without chemotherapy in 19 hospitals in North America, Europe and Australia. The primary objective was to describe the clinical course and to identify factors associated with hospital and intensive care (ICU) admission and mortality.

FINDINGS:

Thirty-five (32%) patients were admitted to hospital and 18 (16%) died. All patients who died had advanced cancer, and only four were admitted to ICU. COVID-19 was the primary cause of death in 8 (7%) patients. Factors independently associated with an increased risk for hospital admission were ECOG ≥2 (OR 39.25, 95% CI 4.17 to 369.2, p=0.0013), treatment with combination ICI (OR 5.68, 95% CI 1.58 to 20.36, p=0.0273) and presence of COVID-19 symptoms (OR 5.30, 95% CI 1.57 to 17.89, p=0.0073). Seventy-six (73%) patients interrupted ICI due to SARS-CoV-2 infection, 43 (57%) of whom had resumed at data cut-off.

INTERPRETATION:

COVID-19-related mortality in the ICI-treated population does not appear to be higher than previously published mortality rates for patients with cancer. Inpatient mortality of patients with cancer treated with ICI was high in comparison with previously reported rates for hospitalized patients with cancer and was due to COVID-19 in almost half of the cases. We identified factors associated with adverse outcomes in ICI-treated patients with COVID-19.

• Authors: Aljosja Rogiers, Ines Pires da Silva, Chiara Tentori, Carlo Alberto Tondini, Joseph M Grimes, Megan H Trager, Sharon Nahm, Leyre Zubiri, Michael Manos, Peter Bowling, Arielle Elkrief, Neha Papneja, Maria Grazia Vitale, April A N Rose, Jessica S W Borgers, Severine Roy, Joanna Mangana, Thiago Pimentel Muniz, Tim Cooksley, Jeremy Lupu, Alon Vaisman, Samuel D Saibil, Marcus O Butler, Alexander M Menzies, Matteo S Carlino, Michael Erdmann, Carola Berking, Lisa Zimmer, Dirk Schadendorf, Laura Pala, Paola Queirolo, Christian Posch, Axel Hauschild, Reinhard Dummer, John Haanen, Christian U Blank, Caroline Robert, Ryan J Sullivan, Paolo Antonio Ascierto, Wilson H Miller Jr, F Stephen Hodi, Karijn P M Suijkerbuijk, Kerry L Reynolds, Osama E Rahma, Paul C Lorigan, Richard D Carvajal, Serigne Lo, Mario Mandala, Georgina V Long
• Journal: Journal for immunotherapy of cancer (J Immunother Cancer) Vol. 9 Issue 1 (01 2021) ISSN: 2051-1426 [Electronic] England
• PMID: 33468556 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Immune Checkpoint Inhibitors

Topics

• Adult
• Aged
• Aged, 80 and over
• COVID-19 (epidemiology, immunology, virology)
• Cohort Studies
• Female
• Humans
• Immune Checkpoint Inhibitors (adverse effects, therapeutic use)
• Male
• Middle Aged
• Neoplasms (drug therapy, immunology)
• Retrospective Studies
• SARS-CoV-2 (immunology, isolation & purification)