Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak

Dai, Mengyuan; Liu, Dianbo; Liu, Miao; Zhou, Fen; Li, Guiling; Chen, Zhen; Zhang, Zhian; You, Hua; Wu, Meng; Zheng, Qichao; Xiong, Yong; Xiong, Huihua; Wang, Chun; Chen, Changchun; Xiong, Fei; Zhang, Yan; Peng, Yiya; Ge, Si-Ping; Zhen, B; Yu, Tong-Fu; Wang, Ling; Wang, Hua; Liu, Yu; Chen, Yeshan; Mei, Jie; Gao, Xiang; Li, Zhuyan; Gan, Lijuan; He, Cancan; Li, Zhen; Shi, Yuying; Qi, Yuwen; Yang, Jing; Tenen, Daniel G.; Chai, Li; Mucci, Lorelei A.; Santillana, Mauricio; Cai, Hongwei

doi:10.1158/2159-8290.cd-20-0422

Cited by 1,469 publications

(1,958 citation statements)

References 21 publications

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“…Notably, we found over half of our patients with lung cancers and COVID-19 required hospitalization and almost a quarter died. These findings from our patients at a single center in New York City add to evidence, supported by reports of outcomes of mostly hospitalized patients with cancer from Hubei province (10,34), throughout China (35), and a cohort largely from northern Italy (27), that patients with lung cancers are a particularly vulnerable population with high rates of severe COVID-19.…”

Section: Discussionsupporting

confidence: 87%

“…Lastly, given the dissipating pharmacodynamic impact of PD-1 blockade following the initial proliferative burst associated with early doses (18)(19)(20)(21), it is possible that any interaction of PD-1 blockadefor better or worseon severity of COVID-19 would be limited to those who recently began therapy. Some (10,(22)(23)(24), but not all (11,(25)(26)(27), initial reports of COVID-19 described signals of increased severity associated with immune checkpoint inhibitors (ICIs). These conclusions may be confounded by multiple factors, such as lung cancer diagnosis and prior smoking, which are associated with both an increased likelihood of ICI exposure and increased COVID-19 severity.…”

Section: Introductionmentioning

confidence: 99%

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Impact of PD-1 Blockade on Severity of COVID-19 in Patients with Lung Cancers

et al. 2020

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Impact of PD-1 Blockade on Severity of COVID-19 in Patients with Lung Cancers

et al. 2020

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“…8,9 Contrary to previous reports, receipt of chemotherapy within 30 days before COVID-19 diagnosis was not associated with a higher risk of complications. 6 Recent major surgery and metastatic disease also did not confer a significant risk of severe COVID-19 disease. Treatment with ICI predicted both hospitalization and severe disease, although there was considerable heterogeneity in ICI treated tumor types, and disease-specific confounding factors could not be specifically addressed.…”

Section: Mainmentioning

confidence: 97%

Determinants of Severity in Cancer Patients with COVID-19 Illness

Robilotti

Babady

Mead

et al. 2020

Preprint

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New York State had 180,458 cases of SARS-CoV-2 and 9385 reported deaths as of April 10th, 2020. Patients with cancer comprised 8.4% of deceased individuals1. Population-based studies from China and Italy suggested a higher COVID-19 death rate in patients with cancer2,3, although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-19 disease4. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. Since March 10th, 2020 Memorial Sloan Kettering Cancer Center performed diagnostic testing for SARS-CoV-2 in symptomatic patients. Overall, 40% out of 423 patients with cancer were hospitalized for COVID-19 illness, 20% developed severe respiratory illness, including 9% that required mechanical ventilation, and 9% that died. On multivariate analysis, age ≥ 65 years and treatment with immune checkpoint inhibitors (ICI) within 90 days were predictors for hospitalization and severe disease, while receipt of chemotherapy within 30 days and major surgery were not. Overall, COVID-19 illness is associated with higher rates of hospitalization and severe outcomes in patients with cancer. Association between ICI and COVID-19 outcomes will need interrogation in tumor-specific cohorts.

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“…This nding was similar to the report by Zhang et al(13) study. Mengyuan et al (6) also showed that the mortality rate in COVID-19 patients with lung cancer was higher than other cancers and that the stage of cancer had a direct correlation with mortality. In our series, in patients with stage IV cancer, mortality and severe events were observed more frequently compared those with stage I-III.…”

Section: Discussionmentioning

confidence: 97%

“…Cancer patients, with an incidence of more than 18 million new cases per year, may constitute a signi cant portion of the COVID-19 infected population (6). In the pandemic situation, these patients are considered highly vulnerable to infectious complications due to their immunocompromised state (7).…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and Cancer: A Comparative Case Series

Mousavi

Rostami

Kiumarsi

et al. 2020

Preprint

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BackgroundCancer patients, with an incidence of more than 18 million new cases per year, may constitute a significant portion of the COVID-19 infected population. In the pandemic situation, these patients are considered highly vulnerable to infectious complications due to their immunocompromised state.Material & MethodsIn this retrospective case series, the documents of solid cancer patients infected by SARS-CoV-2, hospitalized in Shariati hospital (a tertiary care referral center designated for COVID-19 patients, affiliated by Tehran University of Medical Sciences) between 20 February and 20 April 2020, were evaluated. The diagnosis of COVID-19 was based on a positive real-time fluorescence reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 nucleic acids from nasal and/or pharyngeal specimens and/or features of chest CT scan highly suggestive for SARS-CoV-2.ResultsAmong 33 patients with solid cancer, 11 patients had a positive RT-PCR for SARS-CoV-2 and 22 patients had highly suggestive chest CT scan findings in favor of SARS-CoV-2 but negative RT-PCR . The mean age of the patients was 63.9 years, and 54.5% of the patients were males. Age and sex of the patients did not correlate with mortality. There was no difference in COVID-19 symptoms, lymphocytopenia, thrombocytopenia between survived and un-survived cancer patients. However, LDH level was significantly higher (7170±2077 vs. 932.3±324.7, P-value=0.016) and also serum albumin was significantly lower in un-survived group (3.6±0.5 vs. 2.9±0.6 p-value=0.03). Among 16 patients with stage IV cancer, thirteen patients died, which was significantly higher compared to stage I-III cancer patients (81.3% vs. 18.8% P-value= <0.001). In terms of developing complications, sepsis, invasive ventilation and mortality was significantly higher in patients who received cytotoxic chemotherapy within the last 14 days. There was no significant difference between the two groups of positive and negative SARS-CoV-2 RT-PCR regarding their sex, age, cancer type, mean Hemoglobin concentration, Platelet count, lymphocyte count, serum albumin level, ESR and CRP titer or other laboratory findings and also in terms of clinical symptoms and coexisting.ConclusionIn this study, we showed that the mortality rate among cancer patients affected by COVID-19 was higher than general population and this rate has a significant correlation with factors such as the stage of the disease, the type of cancer, the activity of cancer and finally receiving cytotoxic chemotherapy within 14 days before diagnosis of COVID-19. We also showed that the outcome of cancer patients with positive RT-PCR for COVID-19 similar to those with negative RT-PCR with highly suggestive chest CT scan findings.

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Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak

Cited by 1,469 publications

References 21 publications

Impact of PD-1 Blockade on Severity of COVID-19 in Patients with Lung Cancers

Impact of PD-1 Blockade on Severity of COVID-19 in Patients with Lung Cancers

Determinants of Severity in Cancer Patients with COVID-19 Illness

COVID-19 and Cancer: A Comparative Case Series

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