Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19

Abstract

ImportanceCytokine 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.ObjectiveTo 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 ParticipantsThis 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.ExposuresImmunosuppression due to therapy; systemic anticancer therapy (IO or non-IO).Main Outcomes and MeasuresThe 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.ResultsThe 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 RelevanceThis 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 RegistrationClinicalTrials.gov Identifier: NCT04354701

Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19

“…Many non-cancer-specific features (e.g., older age) are more common among individuals with cancer. Moreover, people with cancer may experience immune suppression from the state of malignancy itself or medication-related such as antineoplastic therapy and steroids [1,15], leading to a decreased humoral response to vaccination [16,17], increased risk for breakthrough infection [4,18,19], and worse overall clinical outcomes from COVID-19 [20]. Patients with cancer also have more frequent and prolonged healthcare interactions compared to their peers without chronic or disabling illness, due to the extended temporal nature of antineoplastic treatment and follow-up with multiple providers, often across more than one healthcare settings, leading to increased risk of SARS-CoV-2 transmission [3].…”

Outpatient anti-spike monoclonal antibody administration is associated with decreased morbidity and mortality among patients with cancer and COVID-19

“…Many non-cancer-speci c features (e.g., older age) are more common among individuals with cancer. Moreover, people with cancer may experience immune suppression from the state of malignancy itself or medication-related such as antineoplastic therapy and steroids 1,14 , leading to a decreased humoral response to vaccination 15,16 , increased risk for breakthrough infection 4,17,18 , and worse overall clinical outcomes from COVID-19 19 . Patients with cancer also have more frequent and prolonged healthcare interactions compared to their peers without chronic or disabling illness, due to the extended temporal nature of antineoplastic treatment and follow-up with multiple providers, often across more than one healthcare settings, leading to increased risk of SARS-CoV-2 transmission 3 .…”

Food Insecurity and Nutritional Challenges in Adolescent and Young Adult Cancer Survivors in the U.S.A.: A Narrative Review and Call to Action

“…The COVID-19 pandemic has exacerbated the complications of cancer treatments and survivorship, particularly among AYAs, as illustrated in Figure 1 . Although studies specific to AYA cancer patients are lacking, the “cytokine storm” from COVID-19 can cause high morbidity and mortality in patients with cancer, particularly those who are treated with immunotherapies [ 60 ]. There is also emerging evidence that chronic vitamin D deficiency, which is common in AYA cancer survivors [ 27 ], may increase the immune and inflammatory dysfunctions that lead to poor COVID-19 outcomes [ 61 , 62 ].…”