TY - JOUR
T1 - Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19
AU - COVID-19 and Cancer Consortium
AU - Bakouny, Ziad
AU - Labaki, Chris
AU - Grover, Punita
AU - Awosika, Joy
AU - Gulati, Shuchi
AU - Hsu, Chih-Yuan
AU - Alimohamed, Saif I
AU - Bashir, Babar
AU - Berg, Stephanie
AU - Bilen, Mehmet A
AU - Bowles, Daniel
AU - Castellano, Cecilia
AU - Desai, Aakash
AU - Elkrief, Arielle
AU - Eton, Omar E
AU - Fecher, Leslie A
AU - Flora, Daniel
AU - Galsky, Matthew D
AU - Gatti-Mays, Margaret E
AU - Gesenhues, Alicia
AU - Glover, Michael J
AU - Gopalakrishnan, Dharmesh
AU - Gupta, Shilpa
AU - Halfdanarson, Thorvardur R
AU - Hayes-Lattin, Brandon
AU - Hendawi, Mohamed
AU - Hsu, Emily
AU - Hwang, Clara
AU - Jandarov, Roman
AU - Jani, Chinmay
AU - Johnson, Douglas B
AU - Joshi, Monika
AU - Khan, Hina
AU - Khan, Shaheer A
AU - Knox, Natalie
AU - Koshkin, Vadim S
AU - Kulkarni, Amit A
AU - Kwon, Daniel H
AU - Matar, Sara
AU - McKay, Rana R
AU - Mishra, Sanjay
AU - Moria, Feras A
AU - Nizam, Amanda
AU - Nock, Nora L
AU - Nonato, Taylor K
AU - Panasci, Justin
AU - Pomerantz, Lauren
AU - Portuguese, Andrew J
AU - Provenzano, Destie
AU - Shah, Dimpy P
PY - 2023/1/1
Y1 - 2023/1/1
N2 - 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.
AB - 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.
KW - Humans
KW - Female
KW - Middle Aged
KW - Aged
KW - Male
KW - COVID-19/epidemiology
KW - SARS-CoV-2
KW - Cohort Studies
KW - Retrospective Studies
KW - COVID-19 Testing
KW - Cytokine Release Syndrome/etiology
KW - Immunosuppression Therapy
KW - Immunotherapy/adverse effects
KW - Neoplasms/epidemiology
U2 - 10.1001/jamaoncol.2022.5357
DO - 10.1001/jamaoncol.2022.5357
M3 - Article
C2 - 36326731
SN - 2374-2437
VL - 9
SP - 128
EP - 134
JO - JAMA Oncology
JF - JAMA Oncology
IS - 1
ER -