Clinical Outcomes in COVID-19 Patients Treated with Immunotherapy

SIMPLE SUMMARY: Patients with cancer who contract COVID-19 are very vulnerable to increased complications and illness while actively being treated with chemotherapy or immune checkpoint inhibitors (ICIs). The aim of this retrospective review was to describe the disease course and identify specific risk factors and overall outcomes in COVID-19-affected patients who are also diagnosed with cancer. We examined whether treatment (chemotherapy vs. ICIs) was associated with clinical outcomes, including hospitalization rates, ICU admissions, and any-cause mortality. A total of 121 patients were examined in this study, and 61 (50.4%) received immunotherapy treatment within 12 months. COVID-19-related ICI mortality was higher compared to patients receiving chemotherapy, but patients with better functional status and COVID-19 vaccination had reduced mortality. ICI cessation or delay is unwarranted as long there has been a risk–benefit assessment undertaken with the patient. However, further investigation still needs to be undertaken with a larger cohort, with an emphasis on timing and outcomes between ICI therapy and COVID-19 infection. ABSTRACT: Introduction: The full impact of COVID-19 infections on patients with cancer who are actively being treated with chemotherapy or immune checkpoint inhibitors (ICIs) has not been fully defined. Our goal was to track clinical outcomes in this specific patient population. Methods: We performed a retrospective chart review of 121 patients (age > 18 years) at the University of Alabama at Birmingham from January 2020 to December 2021 with an advanced solid malignancy that were eligible to be treated with ICIs or on current therapy within 12 months of their COVID-19 diagnosis. Results: A total of 121 patients were examined in this study, and 61 (50.4%) received immunotherapy treatment within 12 months. One quarter of the patients on ICIs passed away, compared to 13% of the post-chemotherapy cohort. Patients who were vaccinated for COVID-19 had lower mortality compared to unvaccinated patients (X(2) = 15.19, p < 0.001), and patients with lower ECOG (0.98) were associated with lower mortality compared to patients with worse functional status (0.98 vs. 1.52; t = 3.20; p < 0.01). Conclusions: COVID-19-related ICI mortality was higher compared to patients receiving chemotherapy. However, ICI cessation or delay is unwarranted as long there has been a risk–benefit assessment undertaken with the patient.