Immunotherapy Use Not Associated with Increased Risk of Death in Patients with Cancer and COVID-19

The use of immune checkpoint inhibitors in patients with cancer and COVID-19 was not associated with an increased risk of death, according to data from a retrospective analysis.

“To what extent immune checkpoint inhibition [affects] COVID-19 infection in patients with cancer is unclear,” lead study author Aljosja Rogiers, a medical oncology fellow at Melanoma Institute Australia, said during a presentation of the data during the 2020 AACR Virtual Meeting: COVID-19 and Cancer. “Theoretically, inhibition could either mitigate or exacerbate COVID-19 infection. This study was designed to help us answer this question.”

The multicenter analysis included data from 113 patients with a laboratory-confirmed diagnosis of COVID-19 across treatment centers in North America, Europe and Australia. Patients included in the analysis had received treatment with an immunotherapy agent within 12 months of testing positive for the infection.

Most of the patients (82%) in the analysis received an anti—PD-1 or anti–PD-L1 agent to treat their cancer. Thirteen percent of the patients received a combination of an anti–PD-1 agent and an anti–CTLA-4 drug. The remaining 5% of patients received another, unclassified, immunotherapy drug. Chemotherapy was not used to treat any of the patients.

Assessing hospital and ICU admission, as well as mortality, was the main goal of the study.

As of May 15, 2020, the median age of patients in the analysis was 63 years and more than half (65%) were male. More than half of the patients (64%) were from Europe, 33% were from North America and 3% were from Australia.

Sixty percent of the patients presented with symptoms of COVID-19. Individuals in the study who were asymptomatic were tested if they had contact with someone who tested positive for the infection.

The most common symptoms that occurred in patients with symptoms of COVID-19 included, but were not limited to, fever (68%) and cough (59%). Patients within the study were diagnosed with either melanoma (57%), non-small cell lung cancer (17%), renal cell carcinoma (9%) or another type of cancer (17%). Most of the cases (74%) were treated in the advanced setting.

Twenty-nine percent of patients were admitted to the hospital as a result of a COVID-19 infection. Various forms of treatment were administered to treat the infection, including, but not limited to, antibiotics (25%), oxygen therapy (20%) and glucocorticoids (10%). Five percent of patients were admitted to the ICU, of which, 3% were placed on a mechanical ventilator.

More than half of the patients (61%) admitted to either the hospital or ICU were discharged and 12% remained in the hospital. Nine patients had died by the time data collection was cut off for this study.

Assessment of mortality outcome showed that 92% of patients with cancer and COVID-19 were alive and that 8% died.

None of the nine patient deaths were attributed to immune checkpoint inhibitor treatment. Seven of the deaths were a result of COVID-19 and all patients who died while on the study had advanced cancer.

Two of the patients who died had melanoma, two had non-small cell lung cancer, two had renal cell carcinoma and three had another type of cancer. The median age of patients who died was 72 years.

“Median age of the patients who died was slightly higher [than in the general population,” Rogiers concluded. “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.”

A version of this story originally appeared on OncLive® as, “Immunotherapy Use Does Not Correlate With Increased Mortality in Patients with COVID-19, Cancer.”