Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19

Authors

Ziad Bakouny, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Chris Labaki, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Punita Grover, Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio.
Joy Awosika, Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio.
Shuchi Gulati, Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio.
Chih-Yuan Hsu, Vanderbilt University Medical Center, Nashville, Tennessee.
Saif I. Alimohamed, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina.
Babar Bashir, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
Stephanie Berg, Loyola University Medical Center, Maywood, Illinois.
Mehmet A. Bilen, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Daniel Bowles, University of Colorado, Denver.
Cecilia Castellano, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Aakash Desai, Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
Arielle Elkrief, Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
Omar E. Eton, Hartford Healthcare Cancer Institute, Hartford, Connecticut.
Leslie A. Fecher, University of Michigan Rogel Cancer Center, Ann Arbor.
Daniel Flora, St. Elizabeth Health Care, Edgewood, Kentucky.
Matthew D. Galsky, Tisch Cancer Institute, Mount Sinai, New York.
Margaret E. Gatti-Mays, Division of Medical Oncology, The Ohio State University, Columbus.
Alicia Gesenhues, St. Elizabeth Health Care, Edgewood, Kentucky.
Michael J. Glover, Stanford University, Stanford, California.
Dharmesh Gopalakrishnan, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
Shilpa Gupta, Cleveland Clinic, Cleveland, Ohio.
Thorvardur R. Halfdanarson, Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
Brandon Hayes-Lattin, Knight Cancer Institute, Oregon Health and Science University, Portland.
Mohamed Hendawi, Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.
Emily Hsu, Hartford Healthcare Cancer Institute, Hartford, Connecticut.
Clara Hwang, Henry Ford Cancer Institute, Detroit, Michigan.
Roman Jandarov, Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio.
Chinmay Jani, Mt. Auburn Hospital, Boston, Massachusetts.
Douglas B. Johnson, Vanderbilt University Medical Center, Nashville, Tennessee.
Monika Joshi, Penn State Cancer Institute, Hershey, Pennsylvania.

Document Type

Journal Article

Publication Date

11-3-2022

Journal

JAMA oncology

DOI

10.1001/jamaoncol.2022.5357

Abstract

IMPORTANCE: Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. OBJECTIVE: To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. EXPOSURES: Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). MAIN OUTCOMES AND MEASURES: The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. RESULTS: The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). CONCLUSIONS AND RELEVANCE: This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04354701.

Department

Radiology

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