Oncologic immunomodulatory agents in patients with cancer and COVID-19

  1. Justin Jee
  2. Aaron J. Stonestrom
  3. Sean Devlin
  4. Teresa Nguyentran
  5. Beatriz Wills
  6. Varun Narendra
  7. Michael B. Foote
  8. Melissa Lumish
  9. Santosha A. Vardhana
  10. Stephen M. Pastores
  11. Neha Korde
  12. Dhwani Patel
  13. Steven Horwitz
  14. Michael Scordo
  15. Anthony F. Daniyan

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Abstract

Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. It is unclear how these agents affect patients with cancer who are infected with SARS-CoV-2. 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 as well as level of respiratory support during corticosteroid administration. Corticosteroid administration was associated with worse outcomes prior to use of supplemental oxygen; no statistically significant difference was observed in sicker cohorts. 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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  1. Version published to 10.1038/s41598-021-84137-5
  2. ScreenIT

    SciScore for 10.1101/2020.08.11.20145458: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The MSKCC institutional review board approved the study and waived the requirement for informed consent.
    Consent: The MSKCC institutional review board approved the study and waived the requirement for informed consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using Python 3.7.4 and the “lifelines” package version 0.22.8.
    Python
    suggested: (IPython, RRID:SCR_001658)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite efforts to control for potential confounders, this study has several limitations inherent to retrospective research. Because of the modest number of patients treated with most of the medications in question, more complex multivariate models were not performed. Certain immunomodulatory agents could not be included due to sparse representation. For example, 12 patients in our cohort received intravenous immunoglobulin; five of these patients developed respiratory failure or died. Inferring the harm or benefit of medications such as corticosteroids in a retrospective study is inherently biased. It is plausible that sicker patients were more likely to receive corticosteroids, and that this was not captured by our study variables. Many risk factors for COVID-19 are unknown, and COVID-19 treatment patterns are complex. It is certain that both patient baseline and COVID-19 related confounders exist in our dataset. Randomized, prospective cancer-specific clinical trials are needed to evaluate the safety and effectiveness of these agents in treating cancer patients with COVID-19.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.08.11.20145458v1 on medRxiv