‘Substantial’ COVID-19 Burden Revealed For NY Cancer Patients

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Data from Memorial Sloan Kettering Hospital in New York, USA, add to evidence of the burden of COVID-19 among patients with cancer and raise the possibility of a link between immune checkpoint inhibitor (ICI) therapy use and poor outcome. 

“Our study has the distinct strength of reporting the most extensive single-institution experience in patients with cancer from the epicenter of the US outbreak”, write Mini Kamboj and co-authors from the institution in a letter to Nature Medicine. 

Overall, 423 of 2035 cancer patients tested at the hospital between 10 March and 7 April 2020 were positive for SARS-CoV-2 infection. Over half (56%) of the patients with a confirmed COVID-19 diagnosis were older than 60 years, 56% had metastatic solid tumours and 59% had diabetes, hypertension, chronic kidney disease and/or cardiac disease. 

The COVID-19 patients presented with cough (82%), fever (78%), shortness of breath (44%) or diarrhoea (26%). Forty percent of the group were admitted to hospital, 20% developed severe respiratory illness, 9% required mechanical ventilation, and 12% died within 30 days. 

Multivariate analysis identified key risk factors significantly associated with hospitalisation, namely non-White race (odds ratio [OR]=1.62), a composite of chronic lymphopenia or corticosteroid use (OR=1.85), haematological malignancy (OR=2.49) and receipt of ICI therapy (OR=2.84). 

In addition, severe respiratory illness was significantly predicted age over 65 years (OR=1.67), and use of ICIs (OR=2.74).

“Notably, metastatic disease, recent chemotherapy or major surgery within the previous 30 [days] did not show a significant association with either hospitalization or severe respiratory illness”, the researchers comment.

However, further analysis indicated that lung cancer patients using ICI therapy were more likely than nonusers to be admitted to hospital (83 vs 52%) and develop severe respiratory illness (58 vs 35%). A similar pattern was also found among patients with other solid tumours (47 vs 38% and 26 vs 15%, respectively).

When multivariate analysis was performed for ICI-treatable cancers, hospitalisation among 268 patients was significantly associated with lung cancer (OR=3.89) and ICI use (OR=2.66), while severe respiratory illness among 275 patients was significantly predicted by lung cancer (hazard ratio [HR]=3.31) and ICI use (HR=2.22).

“A possible explanation for this observation is an exacerbation of ICI-related lung injury or ICI-triggered immune dysregulation by T cell hyperactivation, which in turn might facilitate acute respiratory distress syndrome, a dreaded COVID-19 complication”, suggest Mini Kamboj et al. 

And they caution: “Until further evidence is available, it is prudent not to alter treatment decisions but to consider increased vigilance with SARS CoV-2 testing in patients initiating or continuing treatment with ICIs, irrespective of symptoms”, they advise. 

Reference 

Robilotti EV, Babady NE, Mead PA, et al. Determinants of COVID-19 disease severity in patients with cancer. Nat Med; Advance online publication 24 June 2020. DOI: 10.1038/s41591-020-0979-0.