In a registry-based retrospective cohort study reported in JAMA Oncology, Ziad Bakouny, MD, and colleagues in the COVID-19 and Cancer Consortium (CCC19 registry) found that patients receiving cancer immunotherapy who had baseline immunosuppression, but not those without baseline immunosuppression, had an increased risk of greater COVID-19 infection severity and COVID-19–related cytokine storm. A similar relationship was observed among patients receiving systemic therapy other than immunotherapy.
Study Details
The study included 12,046 patients infected with COVID-19 with a current or past diagnosis of cancer reported to the CCC19 registry between March 2020 and May 2020. The primary outcome measure was a 5-point scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; and death. The secondary outcome measure was the occurrence of cytokine storm.
This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially immunotherapy, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.— Ziad Bakouny, MD, and colleagues
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Key Findings
Among the 12,046 patients, 599 (5.0%) received immunotherapy, 4,327 (35.9%) received nonimmunotherapy systemic treatment, and 7,120 (59.1%) received no antineoplastic regimen—each within 3 months prior to COVID-19 diagnosis. Baseline immunosuppression was present in 14%, 21%, and 9% of the three groups, respectively. Cytokine storm occurred in 12% of patients in each group.
No difference in COVID-19 infection severity (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI] = 0.56–1.13) or risk for cytokine storm (aOR = 0.89, 95% CI = 0.41–1.93) was observed in the immunotherapy group vs the untreated group in the total population.
Among patients with baseline immunosuppression, worse COVID-19 infection severity was observed in both the immunotherapy group (aOR = 3.33, 95% CI = 1.38–8.01) and the nonimmunotherapy systemic treatment group (aOR = 1.79, 95% CI = 1.36–2.35), and risk for cytokine storm was higher in both the immunotherapy group (aOR = 4.41, 95% CI = 1.71–11.38) and the nonimmunotherapy systemic treatment group (aOR = 2.32, 95% CI = 1.42–3.79) compared with the no-treatment group.
The investigators concluded, “This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially immunotherapy, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.”
Toni Choueiri, MD, of Dana-Farber Cancer Institute, and Trisha Wise-Draper, MD, of the University of Cincinnati Cancer Center, are the corresponding authors for the JAMA Oncology article.
Disclosure: The study was supported by the National Institutes of Health, National Cancer Institute, Canadian Institute of Health Research, and others. For full disclosures of the study authors, visit jamanetwork.com.
