Oncologic Immunomodulatory Agents in Patients with Cancer and COVID-19
Abstract Background Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. How these agents impact patients with cancer who are infected with SARS-CoV-2 remains unclear.Methods We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N=820). We controlled for cancer-related characteristics known to predispose to worse COVID-19. To address that more acutely ill patients receive therapeutic corticosteroids, we examined patient subsets based on different levels of respiratory support: ≤2 L/min supplemental oxygen, >2L/min supplemental oxygen, and advanced respiratory support prior to death.Results Corticosteroid administration was associated with worse outcomes in the pre-2L supplemental oxygen cohort; no statistically significant difference was observed in the >2L/min supplemental oxygen and post-critical cohorts. Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were lower, and ferritin levels were higher, after corticosteroid administration. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era..
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Preprint| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
bioRxiv.org - (2021) vom: 27. Jan. Zur Gesamtaufnahme - year:2021 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Jee, Justin [VerfasserIn] |
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| Links: |
Volltext [kostenfrei] |
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| doi: |
10.1101/2020.08.11.20145458 |
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| PPN (Katalog-ID): |
XBI018613128 |
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| 520 | |a Abstract Background Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. How these agents impact patients with cancer who are infected with SARS-CoV-2 remains unclear.Methods We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N=820). We controlled for cancer-related characteristics known to predispose to worse COVID-19. To address that more acutely ill patients receive therapeutic corticosteroids, we examined patient subsets based on different levels of respiratory support: ≤2 L/min supplemental oxygen, >2L/min supplemental oxygen, and advanced respiratory support prior to death.Results Corticosteroid administration was associated with worse outcomes in the pre-2L supplemental oxygen cohort; no statistically significant difference was observed in the >2L/min supplemental oxygen and post-critical cohorts. Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were lower, and ferritin levels were higher, after corticosteroid administration. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era. | ||
| 700 | 1 | |a Stonestrom, Aaron J. |e verfasserin |4 aut | |
| 700 | 1 | |a Devlin, Sean |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyentran, Teresa |e verfasserin |4 aut | |
| 700 | 1 | |a Wills, Beatriz |e verfasserin |4 aut | |
| 700 | 1 | |a Narendra, Varun |e verfasserin |4 aut | |
| 700 | 1 | |a Foote, Michael B. |e verfasserin |4 aut | |
| 700 | 1 | |a Lumish, Melissa |e verfasserin |4 aut | |
| 700 | 1 | |a Vardhana, Santosha |e verfasserin |4 aut | |
| 700 | 1 | |a Pastores, Stephen M. |e verfasserin |4 aut | |
| 700 | 1 | |a Korde, Neha |e verfasserin |4 aut | |
| 700 | 1 | |a Patel, Dhwani |e verfasserin |4 aut | |
| 700 | 1 | |a Horwitz, Steven |e verfasserin |4 aut | |
| 700 | 1 | |a Scordo, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Daniyan, Anthony |e verfasserin |4 aut | |
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