Journal article
Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19
JAMA oncology, Vol.9(1), pp.128-134
01/01/2023
DOI: 10.1001/jamaoncol.2022.5357
PMCID: PMC9634600
PMID: 36326731
Abstract
Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation.
To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer.
This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings.
Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO).
The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm.
The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79).
This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.
ClinicalTrials.gov Identifier: NCT04354701.
Details
- Title: Subtitle
- Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19
- Creators
- Ziad Bakouny - Dana-Farber Cancer InstituteChris Labaki - Dana-Farber Cancer InstitutePunita Grover - Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, OhioJoy Awosika - University of CincinnatiShuchi Gulati - University of CincinnatiChih-Yuan Hsu - Vanderbilt University Medical CenterSaif I Alimohamed - Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North CarolinaBabar Bashir - Thomas Jefferson UniversityStephanie Berg - Loyola University Medical CenterMehmet A Bilen - Emory UniversityDaniel Bowles - University of Colorado, DenverCecilia Castellano - Emory UniversityAakash Desai - Mayo Clinic in FloridaArielle Elkrief - Mayo Clinic in FloridaOmar E Eton - Hartford HospitalLeslie A Fecher - University of MichiganDaniel Flora - St. Elizabeth HealthcareMatthew D Galsky - Tisch HospitalMargaret E Gatti-Mays - The Ohio State UniversityAlicia Gesenhues - St. Elizabeth HealthcareMichael J Glover - Stanford UniversityDharmesh Gopalakrishnan - Roswell Park Cancer InstituteShilpa Gupta - Cleveland ClinicThorvardur R Halfdanarson - Mayo Clinic in ArizonaBrandon Hayes-Lattin - University of PortlandMohamed Hendawi - Aurora Health CareEmily Hsu - Hartford HospitalClara Hwang - Henry Ford HospitalRoman Jandarov - University of CincinnatiChinmay Jani - Mount Auburn HospitalDouglas B Johnson - Vanderbilt University Medical CenterMonika Joshi - Penn State Milton S. Hershey Medical CenterHina Khan - Brown UniversityShaheer A Khan - Columbia University Irving Medical CenterNatalie Knox - Loyola University Medical CenterVadim S Koshkin - UCSF Helen Diller Family Comprehensive Cancer CenterAmit A Kulkarni - Masonic Cancer Center, University of Minnesota, MinneapolisDaniel H Kwon - UCSF Helen Diller Family Comprehensive Cancer CenterSara Matar - MUSC Hollings Cancer CenterRana R McKay - University of San DiegoSanjay Mishra - Vanderbilt University Medical CenterFeras A Moria - McGill University Health CentreAmanda Nizam - Cleveland ClinicNora L Nock - Case Western Reserve UniversityTaylor K Nonato - University of California San DiegoJustin Panasci - Jewish General HospitalLauren Pomerantz - Penn State Milton S. Hershey Medical CenterAndrew J Portuguese - Fred Hutch Cancer CenterDestie Provenzano - George Washington UniversityMatthew Puc - Virtua HealthYuan J Rao - George Washington UniversityTerence D Rhodes - Intermountain HealthcareGregory J Riely - Memorial Sloan Kettering Cancer CenterJacob J Ripp - University of Kansas Medical CenterAndrea V Rivera - Thomas Jefferson UniversityErika Ruiz-Garcia - Instituto Nacional de CancerologíaAndrew L Schmidt - Dana-Farber Cancer InstituteAdam J Schoenfeld - Memorial Sloan Kettering Cancer CenterGary K Schwartz - Columbia UniversitySumit A Shah - Stanford UniversityJustin Shaya - University of California San DiegoSuki Subbiah - Stanley S. Scott Cancer Center, LSU, New Orleans, LouisianaLisa M Tachiki - Fred Hutchinson Cancer Research Center, Seattle, WashingtonMatthew D Tucker - Vanderbilt University Medical CenterMelissa Valdez-Reyes - Instituto Nacional de CancerologíaLisa B Weissmann - Mount Auburn HospitalMichael T Wotman - Tisch HospitalElizabeth M Wulff-Burchfield - University of Kansas Medical CenterZhuoer Xie - Mayo ClinicYuanchu James Yang - Vanderbilt University Medical CenterMichael A Thompson - Aurora Health CareDimpy P Shah - The University of Texas Health Science Center at San AntonioJeremy L Warner - Vanderbilt University Medical CenterYu Shyr - Vanderbilt University Medical CenterToni K Choueiri - Dana-Farber Cancer InstituteTrisha M Wise-Draper - University of CincinnatiYousef Zakharia - University of Iowa, Hematology, Oncology, and Blood & Marrow Transplantation
- Contributors
- COVID-19 and Cancer Consortium (Author)Yousef Zakharia (Contributor) - University of Iowa, Hematology, Oncology, and Blood & Marrow Transplantation
- Resource Type
- Journal article
- Publication Details
- JAMA oncology, Vol.9(1), pp.128-134
- DOI
- 10.1001/jamaoncol.2022.5357
- PMID
- 36326731
- PMCID
- PMC9634600
- NLM abbreviation
- JAMA Oncol
- ISSN
- 2374-2437
- eISSN
- 2374-2445
- Grant note
- P30 CA054174 / NCI NIH HHS P30 CA068485 / NCI NIH HHS T32 CA009515 / NCI NIH HHS K12 CA090625 / NCI NIH HHS UL1 TR000445 / NCATS NIH HHS P30 CA008748 / NCI NIH HHS KL2 TR001426 / NCATS NIH HHS UL1 TR001425 / NCATS NIH HHS
- Language
- English
- Date published
- 01/01/2023
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984546645002771
Metrics
8 Record Views