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In the absence of immunosuppression, systemic cancer therapies do not increase the risk of severe COVID-19 or cytokine storm, according to a study published in JAMA Oncology.
Researchers found that cancer patients with baseline immunosuppression who received immunotherapy or other systemic cancer treatments had a higher risk of severe COVID-19 and cytokine storm than immunosuppressed patients who had not received recent cancer treatments.
However, the risk of severe COVID-19 and cytokine storm were not increased by systemic cancer treatments among patients who did not have baseline immunosuppression.
This study (ClinicalTrials.gov Identifier: NCT04354701) included 12,046 patients enrolled in the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. At baseline, the patients had a median age of 65 years, 52.8% were women, and 54.8% were non-Hispanic White.
Most patients (59.1%) had not received any antineoplastic treatment within 3 months prior to their COVID-19 diagnosis. Of the remaining patients, 5.0% received immunotherapy, and 35.9% received systemic cancer therapies other than immunotherapy.
The median follow-up was 90 days (range, 30-180 days). The study’s primary outcome was a 5-level ordinal scale of COVID-19 severity — no complications, hospitalization without oxygen requirement, hospitalization with oxygen requirement, intensive care unit admission and/or mechanical ventilation, and death. The secondary outcome was cytokine storm.
In the absence of baseline immunosuppression, there was no significant difference in the risk of severe COVID-19 between patients who received immunotherapy and patients who received no cancer treatment (adjusted odds ratio [aOR], 0.79; 95% CI, 0.55-1.13). The same was true for the risk of cytokine storm (aOR, 0.88; 95% CI, 0.42-1.84).
Likewise, in the absence of baseline immunosuppression, there was no significant difference in the risk of severe COVID-19 between patients who received other systemic cancer therapies and patients who received no cancer treatment (aOR, 0.97; 95% CI, 0.87-1.08). The same was true for the risk of cytokine storm (aOR, 1.10; 95% CI, 0.89-1.36).
However, among patients with baseline immunosuppression, those who received immunotherapy had a higher risk of severe COVID-19 than patients who received no cancer treatment (aOR, 3.33; 95% CI, 1.38-8.01). Immunosuppressed patients treated with immunotherapy also had a higher risk of cytokine storm (aOR, 4.41; 95% CI, 1.71-11.38).
Among patients with baseline immunosuppression, those treated with non-immunotherapy cancer treatments had a higher risk of severe COVID-19 than patients who received no cancer treatment (aOR, 1.79; 95% CI, 1.36-2.35). Immunosuppressed patients treated with cancer therapies other than immunotherapy also had a higher risk of cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79).
“These findings suggest that patients with cancer with baseline immunosuppression and COVID-19 may experience worse outcomes when treated with IO [immunotherapy] or non-IO systemic anticancer therapy, whereas those without any preexisting immune suppression can safely receive anticancer therapeutic regimens,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Bakouny Z, Labaki C, Grover P et al. Interplay of immunosuppression and immunotherapy among patients with cancer and COVID-19. JAMA Oncol. Published online November 3, 2022. doi:10.1001/jamaoncol.2022.5357
