Determinants of Severity in Cancer Patients with COVID-19 Illness

Abstract

New York State had 180,458 cases of SARS-CoV-2 and 9385 reported deaths as of April 10th, 2020. Patients with cancer comprised 8.4% of deceased individuals1. Population-based studies from China and Italy suggested a higher COVID-19 death rate in patients with cancer2,3, although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-19 disease4. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. Since March 10th, 2020 Memorial Sloan Kettering Cancer Center performed diagnostic testing for SARS-CoV-2 in symptomatic patients. Overall, 40% out of 423 patients with cancer were hospitalized for COVID-19 illness, 20% developed severe respiratory illness, including 9% that required mechanical ventilation, and 9% that died. On multivariate analysis, age ≥ 65 years and treatment with immune checkpoint inhibitors (ICI) within 90 days were predictors for hospitalization and severe disease, while receipt of chemotherapy within 30 days and major surgery were not. Overall, COVID-19 illness is associated with higher rates of hospitalization and severe outcomes in patients with cancer. Association between ICI and COVID-19 outcomes will need interrogation in tumor-specific cohorts.

Characteristics and outcomes of coronavirus disease 2019 (COVID-19) patients with cancer: A single-center retrospective observational study in Tokyo, Japan

“…Some retrospective study did not show any signi cant association between recent cancer treatment and mortality, as with our study [9][10][11][12]. However, one retrospective study in China reported a higher likelihood of experiencing severe events in patients who received antitumor treatment within 14 days of COVID-19 diagnosis [5].…”

“…Meanwhile, immune checkpoint inhibitors may also activate the immune system and cause cytokine release syndrome [28]. One retrospective study reported that immunotherapy within 90 days was an independent risk factor for hospitalization and severe disease in cancer patients [10]. In our study, two patients received immunotherapy within 30 days.…”

Managing the front‐line treatment for diffuse large B cell lymphoma and high‐grade B cell lymphoma during the COVID‐19 outbreak

“…No patients undergoing intensified treatments were infected by SARS‐CoV‐2. Likewise, Robilotti et al 7 . have recently stated that active chemotherapy in the 30 days prior to COVID‐19 does not confer any risk for disease severity, although they show a 12% mortality among cancer patients because of SARS‐CoV‐2 infection, lower than what has been previously published.…”

Cancer and risk of COVID-19 through a general community survey

“…Among >1.8 million participants, we found that individuals living with cancer had a 60% increased risk of COVID-19+ or hospitalization with COVID-19, with greater risks for older individuals or those receiving anti-cancer therapies. Prior studies have shown that individuals with cancer comprise a disproportionate share of poorer COVID-19 outcomes, [3][4][5][6] including death. However, these studies had small sample sizes and are largely based on hospitalized patients, capturing the most severe cases.…”