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Oncologic immunomodulatory agents in patients with cancer and COVID-19

Justin Jee1, Aaron J Stonestrom1, Sean Devlin2

  • 1Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.

Scientific Reports
|March 2, 2021
PubMed

Insights

Cancer patients on corticosteroids experienced worse outcomes with SARS-CoV-2 before supplemental oxygen. Pre-existing neutropenia, not chemotherapy, worsened COVID-19 outcomes, guiding treatment decisions.

Area of Science:

  • Oncology
  • Infectious Diseases
  • Pharmacology

Background:

  • Cancer treatments like corticosteroids, anti-CD20 agents, immunotherapies, and chemotherapy are common.
  • The impact of these cancer therapies on patients with SARS-CoV-2 infection remains unclear.
  • Understanding these effects is crucial for managing cancer patients during the COVID-19 pandemic.

Purpose of the Study:

  • To investigate the association between commonly used cancer medications and COVID-19 outcomes.
  • To determine if pre-existing neutropenia affects COVID-19 severity in cancer patients.
  • To provide data for risk-benefit assessments of cancer treatments during the COVID-19 era.

Main Methods:

  • Retrospective study of 820 cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020.
  • Analysis of associations between respiratory failure or death and receipt of specific cancer medications.
  • Controlled for cancer-related characteristics and respiratory support levels during corticosteroid administration.

Main Results:

  • Corticosteroid use was linked to worse outcomes before supplemental oxygen; no significant difference in sicker cohorts.
  • Immunotherapy and anti-CD20 therapy showed no statistically significant association with worse outcomes in metastatic thoracic and hematologic cancers, respectively.
  • Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was a significant risk factor for severe COVID-19.

Conclusions:

  • Corticosteroid use requires careful consideration in SARS-CoV-2 infected cancer patients, especially before supplemental oxygen.
  • Pre-existing neutropenia is a key factor influencing COVID-19 prognosis in cancer patients.
  • This study offers insights for clinical decision-making regarding cancer therapies during the COVID-19 pandemic in the absence of definitive guidelines.

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