ABSTRACT
Background: ICI are widely used in the treatment of various cancer types. It has been hypothesized that ICI couldconfer an increased risk of severe acute lung injury or other complications associated with severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2). Methods: We analyzed data from 113 patients with laboratory-confirmed COVID-19 while on treatment with ICI without chemotherapy in 19 hospitals in North America, Europe, and Australia. Data collected included details onsymptoms, comorbidities, medications, treatments and investigations for COVID-19, and outcomes (hospitaladmission, ICU admission, and mortality). Results: The median age was 63 years (range 27-86);40 (35%) patients were female. Most common malignancies were melanoma (n=64, 57%), non-small cell lung cancer (n=19, 17%), and renal cell carcinoma (n=11, 10%);30(27%) patients were treated for early (neoadjuvant/adjuvant) and 83 (73%) for advanced cancer. Most patientsreceived anti-PD-1 (n=85, 75%), combination anti-PD-1 and anti-CTLA-4 (n=15, 13%), or anti-PD-L1 (n=8, 7%) ICI.Comorbidities included cardiovascular disease (n=31, 27%), diabetes (n=17, 15%), and pulmonary disease (n=14, 12%). Symptoms were present in 68 (60%) patients;46 (68%) had fever, 40 (59%) cough, and 23 (34%) dyspnea.Overall, ICI was interrupted in 58 (51%) patients. At data cutoff, 33 (29%) patients were admitted to hospital, 6 (5%)to ICU, and 9 (8%) patients died. COVID-19 was the primary cause of death in 7 patients, 3 of whom were admittedto ICU. Cancer types in patients who died were melanoma (2), non-small cell lung cancer (2), renal cell carcinoma(2), and others (3);all (9) patients had advanced cancer. Administered treatments were oxygen therapy (8), mechanical ventilation (2), vasopression (2), antibiotics (7), antiviral drugs (4), glucocorticoids (2), and anti-IL-6 (2).Of all hospitalized patients, 20 (61%) had been discharged and 4 (12%) were still in hospital at data cutoff. Conclusion: The mortality rate of COVID-19 in patients on ICI is higher than rates reported for the generalpopulation without comorbidities but may not be higher than rates reported for the cancer population. Despite thesepreliminary findings, COVID-19 patients on ICI may not have symptoms and a proportion may continue ICI.Correlative analyses are ongoing and will be presented.
ABSTRACT
Background: Early reports suggest a possible increased risk of serious complications and death in COVID-19patients with cancer. However, rigorous comparisons with non-cancer control patients with COVID-19 are lacking. Methods: We systematically identified all patients with a history of cancer admitted to two major academic medicalcenters in Boston with symptomatic COVID-19 infections between 03/13/2020 and 05/10/2020. 162 cases wereidentified, and matched 1:2 by age, gender, race, and admission date with systematically identified controls withouta cancer history. Sociodemographics, comorbidities, presenting symptoms, hospital course, and COVID-19outcomes were extracted from medical records for all patients. Cancer history and treatments were documented forcases. Clinical characteristics and outcomes were compared between cases and controls using conditional logisticregression. Among cancer patients, logistic regression models were fit to identify predictors of death/discharge tohospice. Results: As of 06/05/2020, among 162 cancer patients (median time since diagnosis, 35.6 [range 0.39-435]months;80% with solid tumor, 20%, hematologic diagnosis), 27.8% died or were discharged to hospice and 4.3%were still hospitalized. Among the 324 controls, 25.6% died or were discharged to hospice, and 3.1% were stillhospitalized. Median duration of hospitalization was 9 days for both cases and controls. The proportion of controlswho were intubated (36.1%) was higher than cases (27.2%). The odds of mortality/discharge to hospice (vs.discharge to home/facility) were similar between cancer cases and matched controls (univariable OR: 1.15, 95% CI:0.73-1.82;multivariable OR: 1.54, 95% CI: 0.90-2.65). In multivariable analyses, cancer patients were more likely tobe immunosuppressed (OR: 4.21, 95% CI: 2.42-7.34), to have presented at hospital admission with fatigue (OR:1.71, 95% CI: 1.05-2.78), and were less likely to have a premorbid neurologic condition (OR: 0.37, 95% CI: 0.16-0.82). Among cancer cases, patients with metastatic disease or who had received cancer-directed therapy in thelast 6 months (n=74, 46%) did not have higher odds of death/discharge to hospice following their hospital course(univariable OR: 1.37, 95% CI: 0.68-2.75;multivariable OR: 1.77, 95% CI: 0.80-3.93) compared to patients with noevidence of disease and no treatment within 6 months. Conclusions: Patients with a history of cancer hospitalized for COVID-19 had similar hospital course and mortalityto matched hospitalized COVID-19+ controls without cancer. Additionally, we did not find an association betweenhaving metastatic disease or recent cancer treatment and experiencing an adverse outcome. During the onset andsurge peak of the COVID-19 crisis in Boston, people with a history of cancer admitted to two large teachinghospitals for COVID-19 infection fared no worse than those without a history of cancer.