Cancer patients with weakened immune systems are at high risk of severe COVID if treated with systemic drug therapies, study finds – ScienceDaily

Cancer patients with weakened immune systems who are treated with immunotherapies tend to fare significantly worse from COVID-19 than those who have not received such treatments in the three months prior to their diagnosis of COVID, show the results of a new study led by researchers at Dana-Farber Cancer Institute, and across the United States, Canada and Mexico. Researchers have found worse outcomes in the disease itself as well as the ferocious immune response that sometimes accompanies it.

The study, posted online today by the journal JAMA Oncologyalso found that immunocompromised patients treated with drug agents other than immunotherapies had more severe COVID than untreated patients, but not to the same degree as those receiving immunotherapy.

On the positive side, the researchers found that patients treated with immunotherapies — but whose immune systems were healthy — fared no worse from COVID than untreated patients.

The findings suggest that immunocompromised cancer patients should take particular care to avoid COVID and, if they do contract the disease, should be aggressive in seeking treatment, the study authors said. However, patients whose immune system has not been suppressed can safely receive cancer therapies – immunotherapies or drug agents – without being at additional risk of COVID-19.

“It is well established that COVID-19 disproportionately affects cancer patients, and there is evidence that patients treated with certain types of systemic therapies – which suppress the immune system – often have worse outcomes,” said Toni Choueiri, MD, director of the Lank Center for Genitourinary Oncology, Dana-Farber, co-lead author of the study. “This study was done to find out which patients are most at risk of adverse effects. We looked specifically at patients treated with immunotherapies, which stimulate the immune system to fight cancer, and those treated with other drugs that suppress the immune system.”

Drawing on the COVID-19 and Cancer Consortium (CCC19) registry, researchers analyzed data from 12,046 patients with COVID-19 who had a current or past diagnosis of cancer, making it one of the most large datasets analyzed to date in relation to patients with COVID-19 and cancer. The analysis looked at whether a weakened immune system or immunotherapy treatment was associated with worse COVID-19 outcomes – with hospitalization or death from the disease, and with a “cytokine storm”, an overreaction potentially dangerous immune system to infection.

“We found that patients who were both immunocompromised and treated with immunotherapies fared significantly worse than those who did not receive these therapies,” said Chris Labaki, MD, Dana-Farber, co-lead author of the item. Other co-lead authors are Ziad Bakouny, MD, MSc, Brigham and Women’s Hospital, and Punita Grover, MD, University of Cincinnati Cancer Center.

“Cytokine storm and COVID deaths were three to four times higher in this group,” Bakouny said. The same trend was verified, but to a lesser extent, for immunocompromised patients who had received certain types of systemic treatments. “In this group, cytokine storm and death from COVID were two to three times higher than in untreated patients.”

The results contain important messages for cancer patients as well as their doctors, the study authors said. “Patients at high risk for severe COVID should take steps to keep this risk as low as possible: wearing a mask, avoiding crowded places, keeping up to date with vaccines and reminders,” the researchers said. “High-risk patients who have been exposed to the disease should get tested quickly and, if positive, treated with antibodies or drugs that can reduce the severity of the disease.”

“When counseling patients on treatment, it is important that we discuss the benefits and risks of treatment with systemic therapies in relation to COVID-19,” said Choueiri, who also sits on the CCC19 steering committee. Dana-Farber is a founding institution of CCC19. “The results of this study can help us know what to expect.”

Co-lead authors, with Choueiri, are Yu Shyr, MD, of Vanderbilt University Medical Center, and Trisha M. Wise-Draper, MD, PhD, of the University of Cincinnati Cancer Center. Co-authors are Andrew L. Schmidt, MD, of Dana-Farber; Joy Awosika, MD, Shuchi Gulati, MD, Roman Jandarov, PhD, of the University of Cincinnati Cancer Center; Chih-Yuan Hsu, PhD, Sanjay Mishra, MS, PhD, and James Yang, of Vanderbilt University Medical Center; Saif I. Alimohamed of Wake Forest Baptist Comprehensive Cancer Center; Babar Bashir, MD, MS, and Andrea V. Rivera, MD, of the Sidney Kimmel Cancer Center, Thomas Jefferson University; Stephanie Berg, DO, and Natalie Knox, of Loyola University Medical Center; Mehmet A. Bilen, MD, and Cecilia Castellano, of Winship Cancer Institute, Emory University; Daniel Bowles, MD, of the University of Colorado; Aakash Desai, MD, MPH, Arielle Elkrief, MD, Thorvardur R. Halfdanarson, MD, and Zhuoer Xie, MD, of the Mayo Clinic; Omar E. Eton, MD, and Emily Hsu, MD, of Hartford Healthcare Cancer Institute; Leslie A. Fecher, MD, of the University of Michigan Rogel Cancer Center; Daniel Flora, MD, PharmD, and Alicia Gesenhues, PharmD, BCOP, of St. Elizabeth Health Care, Edgewood, Kentucky; Matthew D. Galsky, MD, and Michael T. Wotman, MD, of the Tisch Cancer Institute, Mount Sinai; Margaret E. Gatti-Mays, MD, MPH, of The Ohio State University; Michael J. Glover, MD, and Sumit A. Shah, MD, of Stanford University; Dharmesh Gopalakrishnan, MD, of Roswell Park Comprehensive Cancer Center; Shilpa Gupta, MD, and Amanda Nizam of the Cleveland Clinic; Brandon Hayes-Lattin, MD of Knight Cancer Institute, Oregon Health and Science University; Mohamed Hendawi, MD, of Aurora Cancer Center, Milwaukee, Wisconsin; Clara Hwang, MD, of the Henry Ford Cancer Institute; Chinmay Jani, MD, and Lisa B. Weissmann, MD, of Mt. Auburn Hospital, Boston, Massachusetts; Monika Joshi, MD, MRCP, and Lauren Pomerantz, MS, of the Penn State Cancer Institute; Hina Khan, MD, of Brown University and the Lifespan Cancer Institute; Shaheer A. Khan, DO, and Gary K. Schwartz, MD, of Herbert Irving Comprehensive Cancer Center, Columbia University; Vadim S. Koshkin, MD, and Daniel H. Kwon, MD, of UCSF, Helen Diller Comprehensive Cancer Center, San Francisco; Amit A. Kulkarni, MD, of the Masonic Cancer Center, University of Minnesota; Sara Matar, MD, of Hollings Cancer Center, MUSC, Charleston; Rana R. McKay, MD, Taylor K. Nonato, and Justin Shaya, MD, of Moores Cancer Center, UCSD, San Diego; Feras A. Moria, from the McGill University Health Centre; Nora L. Nock, PhD, of Case Comprehensive Cancer Center, Cleveland; Justin Panasci, MD, of the Jewish General Hospital, McGill University; Andrew J. Portuguese, MD, and Lisa M. Tachiki, MD of the Fred Hutchinson Cancer Research Center; Destie Provenzano and Yuan J. Rao, MD, of George Washington University; Matthew Puc, MD, of Virtua Health, Marlton, NJ; Terence D. Rhodes, of Intermountain Healthcare, Salt Lake City; Gregory J. Riely, MD, PhD, and Adam J. Schoenfeld, MD, of Memorial Sloan Kettering Cancer Center; Jacob J. Ripp, DO, and Elizabeth M. Wulff-Burchfield, MD, of the University of Kansas Medical Center; Erika Ruiz-Garcia, MD, MSc, and Melissa Valdez-Reyes, MD, of the Instituto Nacional de Cancerologia, Mexico; Suki Subbiah, MD, of Stanley S. Scott Cancer Center, LSU, New Orleans; Michael A. Thompson, MD, PhD, of Tempus Labs, Chicago; and Dimpy P. Shah, MD, PhD, of Mays Cancer Center, UT Health, San Antonio, for the COVID-19 and Cancer Consortium.

The research is supported by grant support from the Vanderbilt Institute for Clinical and Translational Research (NCATS/NIH UL1 TR000445); the National Cancer Institute (P30 CA068485); the National Center for the Advancement of Translational Sciences at the National Institute of Health (2UL1TR001425-05A1; 2KLTR001426-05A1); the Canadian Institutes of Health Research Fellowship; the Henry R. Shibata Fellowship; the Detweiler Travel Fellowship from the Royal College of Physicians and Surgeons of Canada; the American Cancer Society and the Hope Foundation MRSG-16-01-CCE and P30-CA054174; the National Cancer Institute (5P30CA0506036-31); the Melanoma Research Foundation; NIH T32 Research Training Grant; and the Kuni Foundation Discovery Fellowship.

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