Does prior exposure to immune checkpoint inhibitors treatment affect incidence and mortality of COVID-19 among the cancer patients: The systematic review and meta-analysis

Abstract

Background Immune checkpoint inhibitors (ICIs) treatment among cancer patients has been shown to have antiviral effects by reactivating exhausted T cells. However, they could also trigger inflammatory storm. Therefore, prior exposure to ICIs may influence the risk of SARS-CoV2 infection and subsequent mortality. Recent results from studies of ICIs treatment on incidence and mortality of COVID-19 are controversial. Materials and methods We searched databases PubMed, Embase, ISI of Knowledge, Cochrane Central Register of Controlled Trials (CENTRAL), as well as pre-print databases (MedRxiv and BioRxiv) for retrospective and prospective studies comparing ICIs versus other antitumor treatments in cancer patients in the area of COVID-19 pandemic. The primary outcome was the incidence of COVID-19. The secondary outcomes were mortality of COVID-19. Results Twenty-three studies with a total of 117735 patients were selected. Compared with other antitumor treatments, prior exposure to ICIs had not an increased risk of incidence [Odds ratio (OR), 0.84; 95% confidence interval (CI), 0.60-1.18; P=0.32] and mortality (OR, 1.22; 95% CI, 0.91-1.62; P=0.18) of COVID-19 infectioin. Our subgroup and meta-regression analyses indicated that prior exposure to ICIs may reduce the incidence of COVID-19 in metastatic cancer patients. Conclusions There was no significant difference on incidence and mortality of COVID-19 between prior exposure to ICIs with other anti-tumor treatments. ICIs may reduce infection susceptibility of COVID-19 in metastatic cancer patients.

COVID-19 Outcomes in Patients with Cancer Receiving Immune Checkpoint Inhibitors: A Systematic Review

“…In this study, compared with other cancer treatments, ICI treatment neither increased the incidence of COVID-19 (OR 0.84; 95% CI 0.60-1.18) nor the mortality (OR 1.22; 95% CI 0.91-1.62). 37 Other previous systematic reviews showed similar results. [38][39][40] Lazarus et al [38] searched through February 2021 and evaluated other clinical outcomes besides mortality; however, they included 11 studies for analysis, compared with 21 included in our review.…”

“…Our results are consistent with other studies. The most recent systematic review was that published by Liu et al,[ 37 ] with a search performed through May 2021 reporting incidence and mortality. In this study, compared with other cancer treatments, ICI treatment neither increased the incidence of COVID-19 (OR 0.84; 95% CI 0.60-1.18) nor the mortality (OR 1.22; 95% CI 0.91-1.62).…”

Programmed Cell Death Protein 1 Axis Inhibition in Viral Infections: Clinical Data and Therapeutic Opportunities

“…These findings received further support in a prospective study of 292 melanoma patients on ICIs, where treatment was not found to increase the risk of severe infection [ 62 ], as was the case in a large real world study of 228 patients receiving ICIs vs. 456 non-ICI treated patients, where no significant difference in COVID-19 mortality or disease severity was found [ 63 ]. These results were further corroborated by several meta-analyses investigating the incidence and mortality of COVID-19 in patients with prior exposure to an ICI [ 64 , 65 ].…”

COVID-19 and Cancer: Special Considerations for Patients Receiving Immunotherapy and Immunosuppressive Cancer Therapies

“…[24][25][26][27] Last, a number of meta-analyses have pooled studies to assess whether exposure to ICIs affects severe outcomes or mortality in patients with COVID-19 and cancer. [28][29][30][31] For instance, Liu et al 28 pooled data from 19 studies that had an ICI-treated group and a comparator group and showed no association of ICI treatment on mortality (odds ratio, 1.22; 95% CI, 0.91-1.62; p ¼ .18;…”