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.
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.
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.
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.
Journal for immunotherapy of cancer. 2021 Jan [Epub]
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, 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
Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia., FROM Fondazione per la Ricerca Ospedale Maggiore, Bergamo, Italy., Papa Giovanni XXIII Hospital, Bergamo, Italy., Columbia University Irving Medical Center, New York City, New York, USA., The Christie NHS Foundation Trust, Manchester, UK., Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA., Dana Farber Cancer Institute, Boston, Massachusetts, USA., Segal Cancer Centre Jewish General Hospital, McGill University, Montreal, Québec, Canada., Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy., Princess Margaret Cancer Centre - University Health Network, Toronto, Ontario, Canada., Netherlands Cancer Institute, Amsterdam, The Netherlands., Gustave Roussy and Paris-Saclay University, Villejuif, France., Department of Dermatology, University Hospital Zurich, Zurich, Switzerland., Comprehensive Cancer Center Erlangen - EMN, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany., University Hospital Essen & German Cancer Consortium, Partner Site, Essen, Germany., European Institute of Oncology, Milan, Italy., Technical University of Munich, German Cancer Consortium (DKTK), Munich, Germany., University Hospital Schleswig-Holstein, Kiel, Germany., University Medical Center Utrecht, Utrecht, The Netherlands., Unit of Medical Oncology, University of Perugia, Perugia, Italy., Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia .