Journal for ImmunoTherapy of Cancer (Jan 2021)
Clinical impact of COVID-19 on patients with cancer treated with immune checkpoint inhibition
- Dirk Schadendorf,
- Carola Berking,
- Lisa Zimmer,
- Serigne Lo,
- Caroline Robert,
- John Haanen,
- Ines Pires da Silva,
- Paolo Antonio Ascierto,
- Reinhard Dummer,
- Michael Manos,
- Joanna Mangana,
- Marcus O Butler,
- Richard D Carvajal,
- Georgina V Long,
- Alon Vaisman,
- Christian Posch,
- F Stephen Hodi,
- Paola Queirolo,
- Axel Hauschild,
- Christian U Blank,
- Maria Grazia Vitale,
- Carlo Alberto Tondini,
- Leyre Zubiri,
- Arielle Elkrief,
- Karijn P M Suijkerbuijk,
- Mario Mandala,
- Alexander M Menzies,
- Aljosja Rogiers,
- Chiara Tentori,
- Joseph M Grimes,
- Megan H Trager,
- Sharon Nahm,
- Peter Bowling,
- Neha Papneja,
- April A N Rose,
- Jessica S W Borgers,
- Severine Roy,
- Thiago Pimentel Muniz,
- Tim Cooksley,
- Jeremy Lupu,
- Samuel D Saibil,
- Matteo S Carlino,
- Michael Erdmann,
- Laura Pala,
- Ryan J Sullivan,
- Wilson H Miller Jr,
- Kerry L Reynolds,
- Osama E Rahma,
- Paul C Lorigan
Affiliations
- Dirk Schadendorf
- Department of Dermatology, University Hospital of Essen, Essen, Germany
- Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Lisa Zimmer
- Department of Dermatology, University Hospital of Essen, Essen, Germany
- Serigne Lo
- Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia
- Caroline Robert
- Department of Medicine, Gustave Roussy Cancer Campus, Villejuif, France
- John Haanen
- Netherlands Cancer Institute, Amsterdam, The Netherlands
- Ines Pires da Silva
- Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia
- Paolo Antonio Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
- Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Michael Manos
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Joanna Mangana
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Marcus O Butler
- Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Richard D Carvajal
- Columbia University Irving Medical Center, New York City, New York, USA
- Georgina V Long
- Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia
- Alon Vaisman
- Princess Margaret Cancer Centre - University Health Network, Toronto, Ontario, Canada
- Christian Posch
- Technical University of Munich, German Cancer Consortium (DKTK), Munich, Germany
- F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Paola Queirolo
- medical oncologist
- Axel Hauschild
- University Hospital Schleswig-Holstein, Kiel, Germany
- Christian U Blank
- Netherlands Cancer Institute, Amsterdam, The Netherlands
- Maria Grazia Vitale
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
- Carlo Alberto Tondini
- Papa Giovanni XXIII Hospital, Bergamo, Italy
- Leyre Zubiri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Arielle Elkrief
- Segal Cancer Centre Jewish General Hospital, McGill University, Montreal, Québec, Canada
- Karijn P M Suijkerbuijk
- University Medical Center Utrecht, Utrecht, The Netherlands
- Mario Mandala
- Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Alexander M Menzies
- Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia
- Aljosja Rogiers
- Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia
- Chiara Tentori
- FROM Fondazione per la Ricerca Ospedale Maggiore, Bergamo, Italy
- Joseph M Grimes
- Columbia University Irving Medical Center, New York City, New York, USA
- Megan H Trager
- Columbia University Irving Medical Center, New York City, New York, USA
- Sharon Nahm
- The Christie NHS Foundation Trust, Manchester, UK
- Peter Bowling
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Neha Papneja
- Segal Cancer Centre Jewish General Hospital, McGill University, Montreal, Québec, Canada
- April A N Rose
- Princess Margaret Cancer Centre - University Health Network, Toronto, Ontario, Canada
- Jessica S W Borgers
- Netherlands Cancer Institute, Amsterdam, The Netherlands
- Severine Roy
- Gustave Roussy and Paris-Saclay University, Villejuif, France
- Thiago Pimentel Muniz
- Princess Margaret Cancer Centre - University Health Network, Toronto, Ontario, Canada
- Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
- Jeremy Lupu
- Gustave Roussy and Paris-Saclay University, Villejuif, France
- Samuel D Saibil
- Princess Margaret Cancer Centre - University Health Network, Toronto, Ontario, Canada
- Matteo S Carlino
- Melanoma Institute Australia and University of Sydney, Sydney, New South Wales, Australia
- Michael Erdmann
- Comprehensive Cancer Center Erlangen – EMN, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Laura Pala
- medical oncologist
- Ryan J Sullivan
- Harvard Medical School, Boston, Massachusetts, USA
- Wilson H Miller Jr
- Segal Cancer Centre Jewish General Hospital, McGill University, Montreal, Québec, Canada
- Kerry L Reynolds
- Division of Oncology, Massachusetts General Hospital, Boston, MA, USA
- Osama E Rahma
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Paul C Lorigan
- The Christie NHS Foundation Trust, Manchester, UK
- DOI
- https://doi.org/10.1136/jitc-2020-001931
- Journal volume & issue
-
Vol. 9,
no. 1
Abstract
Background Patients with cancer who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are more likely to develop severe illness and die compared with those without cancer. The impact of immune checkpoint inhibition (ICI) on the severity of COVID-19 illness is unknown. The aim of this study was to investigate whether ICI confers an additional risk for severe COVID-19 in patients with cancer.Methods We analyzed data from 110 patients with laboratory-confirmed SARS-CoV-2 while on treatment with ICI without chemotherapy in 19 hospitals in North America, Europe and Australia. The primary objective was to describe the clinical course and to identify factors associated with hospital and intensive care (ICU) admission and mortality.Findings Thirty-five (32%) patients were admitted to hospital and 18 (16%) died. All patients who died had advanced cancer, and only four were admitted to ICU. COVID-19 was the primary cause of death in 8 (7%) patients. Factors independently associated with an increased risk for hospital admission were ECOG ≥2 (OR 39.25, 95% CI 4.17 to 369.2, p=0.0013), treatment with combination ICI (OR 5.68, 95% CI 1.58 to 20.36, p=0.0273) and presence of COVID-19 symptoms (OR 5.30, 95% CI 1.57 to 17.89, p=0.0073). Seventy-six (73%) patients interrupted ICI due to SARS-CoV-2 infection, 43 (57%) of whom had resumed at data cut-off.Interpretation COVID-19–related mortality in the ICI-treated population does not appear to be higher than previously published mortality rates for patients with cancer. Inpatient mortality of patients with cancer treated with ICI was high in comparison with previously reported rates for hospitalized patients with cancer and was due to COVID-19 in almost half of the cases. We identified factors associated with adverse outcomes in ICI-treated patients with COVID-19.
