Immunotherapy Use Does Not Correlate With Increased Mortality in Patients with COVID-19, Cancer

Aljosja Rogiers

Treatment with immune checkpoint inhibitors (ICIs) did not increase the risk of mortality in patients with COVID-19 and cancer, according to findings from a multicenter, retrospective analysis presented during the 2020 AACR Virtual Meeting: COVID-19 and Cancer.

Data showed that the mortality rate of patients with COVID-19 and cancer who received immuno-oncology agents was 8%. “This rate is similar to the mortality rate in the general cancer population, which is reported to be in the range of 7.6% to 12%,” lead study author, Aljosja Rogiers, said during the medical meeting.

Nine of the 113 patients included in the study population died, however, none of these deaths were attributed to treatment with checkpoint inhibitors. All patients who died on study had advanced cancer; 7 died due to COVID-19.

The analysis by Rogiers et al analysis included data from 113 patients with laboratory-confirmed COVID-19 from 19 centers across North America, Europe, and Australia who received immunotherapy within 12 months of testing positive for COVID-19. Most patients (82%) received 1 anti–PD-1 or PD-L1 agent; 13%, an anti–PD-1 agent in combination with an anti–CTLA-4 drug; and 5%, another immunologic therapy. None of the patients were treated with chemotherapy. Data points included symptoms, comorbidities, and medications, in addition to investigations and treatments implemented for COVID-19. Investigators assessed the following outcomes: hospital and intensive care unit (ICU) admission and mortality.

The evaluation was conducted to shed light on the clinical implications of immune checkpoint blockade. “To what extent immune checkpoint inhibition [affects] COVID-19 infection in patients with cancer is unclear. Theoretically, inhibition could either mitigate or exacerbate COVID-19 infection. This study was designed to help us answer this question,” said Rogiers, a fellow at the Melanoma Institute Australia, in Sydney.

Patient Characteristics

At the data cutoff of May 15, 2020, the median age was 63 years (range, 27-86) and the majority of patients (65%) were male. Few patients had an ECOG performance status of 2 or greater compared with 0 to 1 (10% vs 90%). Regarding the geographic regions to which patients belonged, most of the patients included in the analysis were from Europe (64%). North America and Australia accounted for 33% and 3% of the patient population, respectively.

Sixty percent of the 113 patients were symptomatic for COVID-19. Having contact with someone who was COVID-19–positive provided the rationale for testing the asymptomatic individuals included in this study, Rogiers said. Among the symptomatic patients, fever (68%) and cough (59%) were the symptoms of COVID-19 witnessed, followed by dyspnea (34%) and myalgia (15%). Beyond diabetes, which affected 15% of patients, the comorbidities that investigators observed were of a cardiovascular (27%), pulmonary (12%), and renal (5%) nature. When investigators examined the use of immunosuppressive agents used in this population, they noted the use of 10 mg or more of prednisone per day in 13% of patients, and use of another immunosuppressive agent in 3%.

Fifty-seven percent of patients had melanoma; 17%, melanoma; 9%, renal cell carcinoma (RCC); and 17%, another type of cancer. Most cases were treated in the advanced/metastatic setting (74%); 26% were addressed with a neoadjuvant treatment intervention. Reponses to therapy were as follows: partial response, complete response, or no evidence of disease, 30%; stable disease, 18%; progressive disease, 15%; not available, 37%.

Hospital, ICU Admissions and Mortality Outcomes

Twenty-nine percent of patients were admitted to the hospital, where antibiotics, oxygen therapy, glucocorticoids, antivirals, intravenous immunoglobulins, and anti–interleukin-6 agents were administered to 25%, 20%, 10%, 6%, 2%, and 2% of patients, respectively. Five percent of patients were admitted to the ICU, where were put on mechanical ventilation and vasopressin (3%; 2%). One percent underwent renal replacement therapy.

Results from the outcome concerning hospital and ICU admission showed that 61% of patients were discharged, 12% remained in the hospital, and 27% of those admitted (9 patients) had died by the data cutoff. Data from the mortality outcome assessment demonstrated that 92% of the 113 patients were alive and 8% (9 patients) died.

“Median age of the patients who died was slightly higher [than in the general population,” Rogiers said, citing the median as 72 years (range, 49-81). Among the patients who died, 2 had melanoma; 2, NSCLC; 2, RCC; and 3, another type of cancer. “Although the numbers are small, they may indicate that COVID-19 has a slightly higher mortality rate in patients with non–small cell lung cancer than melanoma, given that 57% of patients had melanoma and 17% of patients had non–small cell lung cancer,” he added.

Seven of the patients who died were treated with an anti–PD-1 agent. The other 2 patients received a combination anti–PD-1 and anti–CTLA-4 regimen.

Reference

Rogiers A, Tondini C, Grimes JM, et al. Clinical characteristics and outcomes of coronavirus 2019 disease (COVID-19) in cancer patients treated with immune checkpoint inhibitors (ICI). Presented at: 2020 AACR Virtual Meeting: COVID-19 and Cancer; July 20-23; Virtual.