According to the results of a recently published retrospective study in Nature Medicine, patients with cancer who contract COVID-19 may be at greater risk for hospitalization and severe disease if they are undergoing treatment with immune checkpoint inhibitors (ICIs). In the study, researchers evaluated 423 patients who developed symptomatic COVID-19 while undergoing treatment for cancer to ascertain whether these patients were at greater risk for complications from the novel virus. 

In the study, more than 50% of patients were aged older than 60 years (n = 234). The most common cancer types included breast cancer (n = 86), lymphoma (n = 48), colorectal cancer (n = 37), and lung cancer (n = 35). Additionally, 56% of patients (n = 238) had metastatic solid tumors and 59% (n = 248) had at least one specified comorbid condition—including diabetes, hypertension, chronic kidney disease, and cardiac disease. The following COVID-19 symptoms were documented: cough (82%), fever (78%), shortness of breath (44%), and diarrhea (26%). The researchers revealed that 40% of patients were hospitalized for COVID-19, 20% developed severe respiratory illness (including 9% who required mechanical ventilation), and 12% died within 30 days. 

In the publication, the authors stated, “A notable finding of our study is the association of checkpoint inhibitor immunotherapy as a risk factor for severe outcomes in patients treated with [immune checkpoint inhibitors], which was independent of age, cancer type and other comorbid conditions. Although we observed more severe COVID-19 in immune checkpoint inhibitor recipients with underlying lung cancer, patients with [other cancers] who were treated with immune checkpoint inhibitors also demonstrated severe outcomes. 

“A possible explanation for this observation is an exacerbation of checkpoint inhibitor–related lung injury or checkpoint inhibitor–triggered immune dysregulation by T-cell hyperactivation, which in turn might facilitate acute respiratory distress syndrome, a dreaded COVID-19 complication,” continued the authors. “The association of checkpoint inhibitor treatment with other severe infections is influenced by the use of corticosteroids for control of immune-mediated adverse events.” 

The authors concluded that age older than 65 years and treatment with ICIs were predictors for hospitalization and severe disease, whereas receipt of chemotherapy and major surgery were not. They also noted that overall, COVID-19 in patients with cancer is characterized by significant rates of hospitalization and severe outcomes. The connection found between ICI and COVID-19 outcomes in the study warrants further examination in tumor-specific cohorts. 

In a press release, one of the lead authors, Mini Kamboj, MD, chief medical epidemiologist at Memorial Sloan Kettering Cancer Center, stated, “The course and clinical spectrum of this disease is still not fully understood, and this is just one of many studies that will need to be done on the connections between cancer and COVID-19. But the big message is now clear: people shouldn’t stop or postpone cancer treatment.” 

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