Immune checkpoint inhibitor therapy and outcomes from SARS-CoV-2 infection in patients with cancer: a joint analysis of OnCovid and ESMO-CoCARE registries
Authors: Cortellini Alessio , Dettorre Gino M , Dafni Urania , Aguilar-Company Juan , Castelo-Branco Luis , Lambertini Matteo , Gennatas Spyridon , Angelis Vasileios , Sita-Lumsden Ailsa , Rogado Jacobo , Pedrazzoli Paolo , Viñal David , Prat Aleix , Rossi Maura , Berardi Rossana , Alonso-Gordoa Teresa , Grisanti Salvatore , Dimopoulou Georgia , Queirolo Paola , Pradervand Sylvain , Bertuzzi Alexia , Bower Mark , Arnold Dirk , Salazar Ramon , Tucci Marco , Harrington Kevin J , Mazzoni Francesca , Mukherjee Uma , Tsourti Zoi , Michielin Olivier , Pommeret Fanny , Brunet Joan , Vincenzi Bruno , Tonini Giuseppe , Patriarca Andrea , Biello Federica , Krengli Marco , Tabernero Josep , Pentheroudakis George , Gennari Alessandra , Peters Solange , Romano Emanuela , Pinato David J 
Published: November 2022

Background

As management and prevention strategies against COVID-19 evolve, it is still uncertain whether prior exposure to immune checkpoint inhibitors (ICIs) affects COVID-19 severity in patients with cancer.

Methods

In a joint analysis of ICI recipients from OnCovid (NCT04393974) and European Society for Medical Oncology (ESMO) CoCARE registries, we assessed severity and mortality from SARS-CoV-2 in vaccinated and unvaccinated patients with cancer and explored whether prior immune-related adverse events (irAEs) influenced outcome from COVID-19.

Findings

The study population consisted of 240 patients diagnosed with COVID-19 between January 2020 and February 2022 exposed to ICI within 3 months prior to COVID-19 diagnosis, with a 30-day case fatality rate (CFR30) of 23.6% (95% CI 17.8 to 30.7%). Overall, 42 (17.5%) were fully vaccinated prior to COVID-19 and experienced decreased CFR30(4.8% vs 28.1%, p=0.0009), hospitalization rate (27.5% vs 63.2%, p<0.0001), requirement of oxygen therapy (15.8% vs 41.5%, p=0.0030), COVID-19 complication rate (11.9% vs 34.6%, p=0.0040), with a reduced need for COVID-19-specific therapy (26.3% vs 57.9%, p=0.0004) compared with unvaccinated patients. Inverse probability of treatment weighting (IPTW)-fitted multivariable analysis, following a clustered-robust correction for the data source (OnCovid vs ESMO CoCARE), confirmed that vaccinated patients experienced a decreased risk of death at 30 days (adjusted OR, aOR 0.08, 95% CI 0.01 to 0.69).

Overall, 38 patients (15.8%) experienced at least one irAE of any grade at any time prior to COVID-19, at a median time of 3.2 months (range 0.13–48.7) from COVID-19 diagnosis. IrAEs occurred independently of baseline characteristics except for primary tumor (p=0.0373) and were associated with a significantly decreased CFR30(10.8% vs 26.0%, p=0.0462) additionally confirmed by the IPTW-fitted multivariable analysis (aOR 0.47, 95% CI 0.33 to 0.67). Patients who experienced irAEs also presented a higher median absolute lymphocyte count at COVID-19 (1.4 vs 0.8 109 cells/L, p=0.0098).

Conclusion

Anti-SARS-CoV-2 vaccination reduces morbidity and mortality from COVID-19 in ICI recipients. History of irAEs might identify patients with pre-existing protection from COVID-19, warranting further investigation of adaptive immune determinants of protection from SARS-CoV-2.