Impact of COVID-19 on Patients with Cancer Receiving Immune Checkpoint Inhibitors

Ai-Tram N Bui; Kevin Tyan; Anita Giobbie-Hurder; Isaac A Klein; Michael P Manos; Leyre Zubiri; Kerry Reynolds; Shilpa Grover; Gerald L Weinhouse; Patrick A Ott; Nicole R LeBoeuf; Osama Rahma

doi:10.36401/JIPO-20-34

Impact of COVID-19 on Patients with Cancer Receiving Immune Checkpoint Inhibitors

J Immunother Precis Oncol. 2021 May 14;4(2):35-44. doi: 10.36401/JIPO-20-34. eCollection 2021 May.

Authors

Ai-Tram N Bui¹, Kevin Tyan¹, Anita Giobbie-Hurder², Isaac A Klein^{3

4

5}, Michael P Manos³, Leyre Zubiri⁶, Kerry Reynolds⁶, Shilpa Grover^{1

7}, Gerald L Weinhouse⁸, Patrick A Ott³, Nicole R LeBoeuf^{1

9}, Osama Rahma^{1

3

4}

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.
³ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
⁴ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁵ Whitehead Institute of Biomedical Research, Cambridge, MA, USA.
⁶ Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
⁷ Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁹ Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.

Abstract

Introduction: To evaluate the impact of Sars-Cov-2 infection on mortality and immune checkpoint inhibitor (ICI) toxicity in patients with cancer receiving ICIs compared to those not receiving ICIs.

Methods: We conducted a retrospective matched cohort study of 25 patients receiving ICIs within 1 year of coronavirus disease 2019 (COVID-19) diagnosis between March 20, 2020, and June 3, 2020, at the Dana-Farber Cancer Institute/Mass General Brigham. Cases were matched 1:1 with controls based on age, sex, and anticancer therapy within the prior 6 months.

Results: Seven of 25 (28%) patients receiving ICIs died from COVID-19 as compared with nine of 25 (36%) controls. Through multivariable analysis adjusting for age, sex, and anticancer therapy, ICI use was not associated with increased risk for COVID-19 death (OR [odds ratio] 0.36, 95% CI 0.07-1.87). Determinants of mortality included age (OR 1.14, 95% CI 1.03-1.27) and chronic obstructive pulmonary disease (OR 12.26, 95% CI 1.76-85.14). Statin use was protective against mortality (OR 0.08, 95% CI 0.01-0.63). Two patients experienced persistent immune-related adverse events (irAEs) (hypophysitis); one had new-onset irAE (hypothyroidism) during their COVID-19 course. Patients with ICIs had significantly higher platelet (p = 0.017) and D-dimer (p = 0.037) levels. Elevated troponin levels (p = 0.01) were associated with COVID-19 death in patients using ICI.

Conclusion: There is insufficient evidence to conclude COVID-19-related outcomes are associated with ICIs, and we did not observe an increased risk of COVID-19-related death associated with ICIs. The potential protective effect of statin therapy and role of laboratory biomarkers warrant further investigation.

Keywords: COVID-19; cancer; cytotoxic T-lymphocyte–associated protein 4; immune checkpoint inhibitors; immune-related adverse events; programmed death 1; programmed death ligand 1.

Grants and funding

Source of Support: None.