Treatment with immune checkpoint inhibitors may lead to more severe COVID-19 illness
Click Here to Manage Email Alerts
Patients with cancer who contract COVID-19 may be at a higher risk for hospitalization and severe disease if they are undergoing treatment with immune checkpoint inhibitors, according to results of a retrospective study published in Nature Medicine.
Age older than 65 years also appeared to predict these COVID-19 outcomes among patients with cancer, but chemotherapy or major surgery did not, according to the researchers. They noted that the relationship with immune checkpoint inhibitors needs to be tested in tumor-specific cohorts.
“The course and clinical spectrum of this disease is still not fully understood, and this is just one of many studies that will need to be done on the connections between cancer and COVID-19,” Mini Kamboj, MD, chief medical epidemiologist at Memorial Sloan Kettering Cancer Center, said in a press release. “But the big message is now clear: people shouldn’t stop or postpone cancer treatment.”
Studies conducted outside the United States have suggested patients with cancer who are on active therapy may have higher risk for severe COVID-19-related events.
Kamboj and colleagues analyzed 423 patients (50% female; 62% white) at Memorial Sloan Kettering Cancer Center who developed symptomatic COVID-19 while undergoing cancer treatment to determine whether they had a higher risk for complications from the novel coronavirus.
More than half of the patients were aged older than 60 years (n = 234). The most frequent cancer types included breast cancer (n = 86), lymphoma (n = 48), colorectal cancer (n = 37) and lung cancer (n = 35).
Fifty-six percent of patients (n = 238) had metastatic solid tumors and 59% (n = 248) had at least one specified comorbid condition — including diabetes, hypertension, chronic kidney disease and cardiac disease.
COVID-19 symptoms included cough (82%), fever (78%), shortness of breath (44%) and diarrhea (26%).
Overall, 168 patients (40%) underwent hospitalization because of COVID-19. Eighty-seven patients (20%) developed severe respiratory illness; 47 of them required high-flow oxygen and 40 required mechanical ventilation.
Patients received several investigational treatments, including hydroxychloroquine, azithromycin, remdesivir (GS-5734, Gilead Sciences), tocilizumab (Actemra, Genentech), convalescent plasma and corticosteroids.
Seven pediatric patients experienced mild illness without complications.
Fifty-one patients (12%) died.
Multivariate analysis showed certain risk factors for hospitalization due to COVID-19. They included treatment with immune checkpoint inhibitors, having a hematologic malignancy, “non-white race,” and a composite measure of chronic lymphopenia or corticosteroid use. Univariate analysis showed other predictors, including age older than 65 years, current or former smoking status, hypertension or chronic kidney disease and history of cardiac disorders.
Metastatic disease, recent chemotherapy or major surgery within the previous 30 days did not appear significantly associated with hospitalization or severe respiratory illness due to COVID-19.
Researchers observed that PD-1 blockade, which is commonly used to treat lung cancer, led to higher frequencies of hospitalization and severe respiratory illness.
“A notable finding of our study is the association of checkpoint inhibitor immunotherapy as a risk factor for severe outcomes in patients treated with [immune checkpoint inhibitors], which was independent of age, cancer type and other comorbid conditions,” Kamboj and colleagues wrote. “Although we observed more severe COVID-19 in immune checkpoint inhibitor recipients with underlying lung cancer, patients with [other cancers] who were treated with immune checkpoint inhibitors also demonstrated severe outcomes.
“A possible explanation for this observation is an exacerbation of checkpoint inhibitor-related lung injury or checkpoint inhibitor-triggered immune dysregulation by T-cell hyperactivation, which in turn might facilitate acute respiratory distress syndrome, a dreaded COVID-19 complication,” researchers added. “The association of checkpoint inhibitor treatment with other severe infections is influenced by the use of corticosteroids for control of immune-mediated adverse events.”
Collapse
Click Here to Manage Email Alerts