New York City data suggest link between immunotherapy, poor COVID-19 outcomes
medwireNews: Treatment with immune checkpoint inhibitors (ICIs) may increase the risk for poor outcomes among patients with cancer and comorbid SARS-CoV-2 infection, indicate data from New York City in the USA.
The researchers from Memorial Sloan Kettering Cancer Center (MSKCC) found that ICI therapy was an independent predictor of the risk for hospitalization and severe respiratory disease.
This finding is in contrast to another study from their institution that did not find “a discernible association” between PD-1 blockade and COVID-19 outcomes in patients with lung cancer, explain Mini Kamboj and colleagues.
“It is important to note that these two studies had distinct endpoints and small overlapping study populations,” write the study authors in Nature Medicine.
And they add: “Until further evidence is available, it is prudent not to alter treatment decisions but to consider increased vigilance with SARS CoV-2 testing in patients initiating or continuing treatment with ICIs, irrespective of symptoms.”
The study included 423 patients (56% aged >60 years) who were diagnosed with COVID-19 at MSKCC between 10 March and 7 April 2020 and had a minimum follow-up of 30 days. The most common tumor type in the cohort was breast cancer (20%), followed by lymphoma (11%), colorectal cancer (9%), lung cancer (8%), and leukemia (8%); more than half had metastatic disease (56%).
In all, 40% of the patients were hospitalized (an additional 3% were already in hospital) and 20% developed severe respiratory illness, which was defined as the need for high-flow oxygen supplementation (11%) or mechanical ventilation (9%).
The case fatality rate for the whole cohort was 12%, which rose to 24% for patients who were admitted to hospital and to 35% for those needing intensive care.
“Overall, COVID-19 in patients with cancer is marked by substantial rates of hospitalization and severe outcomes,” summarize Kamboj and team.
They also investigated factors predictive of poor outcomes, finding that ICI use was significantly associated with an increased risk for hospitalization and severe respiratory illness, at odds ratios (ORs) of 2.84 and 2.74, respectively, after adjusting for confounders.
The researchers point out that although they “observed more severe COVID-19 in ICI recipients with underlying lung cancer, patients with non-lung cancer who were treated with ICI also demonstrated severe outcomes.”
The team continues: “A possible explanation for this observation is an exacerbation of ICI-related lung injury or ICI-triggered immune dysregulation by T cell hyperactivation, which in turn might facilitate acute respiratory distress syndrome, a dreaded COVID-19 complication.”
Other factors associated with hospitalization risk were non-White race, a composite of chronic lymphopenia and/or corticosteroid use, and hematologic cancer, with significant ORs of 1.62, 1.85, and 2.49, respectively.
The only other factor significantly associated with the risk for severe respiratory illness was age of more than 65 years, at an OR of 1.67.
“Notably, metastatic disease, recent chemotherapy or major surgery within the previous 30 [days] did not show a significant association with either hospitalization or severe respiratory illness,” say the authors.
They conclude: “Continuous preparedness is paramount as routine cancer care is resumed in the coming weeks and months amidst the unpredictable threat posed by COVID-19.
“Informed approaches with universal screening, aggressive testing and rigorous control measures will be essential for the safe ongoing delivery of oncologic care.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
10 July 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.