In a registry-based retrospective cohort study reported in JAMA Oncology, Ziad Bakouny, MD, and colleagues in the COVID-19 and Cancer Consortium (CCC19 registry) found that patients receiving cancer immunotherapy who had baseline immunosuppression, but not those without baseline immunosuppression, had an increased risk of greater COVID-19 infection severity and COVID-19–related cytokine storm. A similar relationship was observed among patients receiving systemic therapy other than immunotherapy.
The study included 12,046 patients infected with COVID-19 with a current or past diagnosis of cancer reported to the CCC19 registry between March 2020 and May 2020. The primary outcome measure was a 5-point scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; and death. The secondary outcome measure was the occurrence of cytokine storm.
This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially immunotherapy, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.— Ziad Bakouny, MD, and colleagues
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Among the 12,046 patients, 599 (5.0%) received immunotherapy, 4,327 (35.9%) received nonimmunotherapy systemic treatment, and 7,120 (59.1%) received no antineoplastic regimen—each within 3 months prior to COVID-19 diagnosis. Baseline immunosuppression was present in 14%, 21%, and 9% of the three groups, respectively. Cytokine storm occurred in 12% of patients in each group.
No difference in COVID-19 infection severity (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI] = 0.56–1.13) or risk for cytokine storm (aOR = 0.89, 95% CI = 0.41–1.93) was observed in the immunotherapy group vs the untreated group in the total population.
Among patients with baseline immunosuppression, worse COVID-19 infection severity was observed in both the immunotherapy group (aOR = 3.33, 95% CI = 1.38–8.01) and the nonimmunotherapy systemic treatment group (aOR = 1.79, 95% CI = 1.36–2.35), and risk for cytokine storm was higher in both the immunotherapy group (aOR = 4.41, 95% CI = 1.71–11.38) and the nonimmunotherapy systemic treatment group (aOR = 2.32, 95% CI = 1.42–3.79) compared with the no-treatment group.
The investigators concluded, “This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially immunotherapy, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.”
Toni Choueiri, MD, of Dana-Farber Cancer Institute, and Trisha Wise-Draper, MD, of the University of Cincinnati Cancer Center, are the corresponding authors for the JAMA Oncology article.
Disclosure: The study was supported by the National Institutes of Health, National Cancer Institute, Canadian Institute of Health Research, and others. For full disclosures of the study authors, visit jamanetwork.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.