Prior ICI therapy potentially improves COVID-19 outcomes in cancer patients

Previous exposure to immune checkpoint inhibitors (ICIs) does not appear to worsen COVID-19 outcomes but may even improve them in patients with cancer, according to a study.

For the study, researchers used the OnCovid registry and screened 3,523 patients who received systemic anticancer therapy (SACT) in the 4 weeks before laboratory-confirmed COVID-19 diagnosis.

Predefined clinical outcomes between patients who and those who had not received ICIs were compared using propensity score matching based on country, vaccination status, primary tumour type, sex, age, morbidity burden, tumour stage, and remission status.

Of the patients screened, 1,515 met the inclusion criteria, including 137 in the ICI-exposed group and 1,378 in the nonexposed group. The most common ICI administered was PD-1/PD-L1 checkpoint inhibitor monotherapy (78.1 percent), followed by PD-1/PD-L1 and CTLA-4 inhibitor combinations (9.5 percent), experimental monotherapy (9.5 percent), and experimental combinations (2.9 percent).

Overall, most patients were unvaccinated (81.8 percent), with the proportion being slightly lower in the exposed vs nonexposed group (77.0 percent vs 82.2 percent; p=0.09). Most vaccinated patients received an mRNA vaccine. The proportions of patients with 0 to 1 or ≥2 comorbidities were similar in the two groups.

The analysis included 120 patients in the exposed group and 322 in the unexposed group. There was no significant between-group differences in terms of COVID-19 symptoms presentation (odds ratio [OR], 0.69, 95 percent confidence interval [CI], 0.37–1.28), receipt of COVID-specific therapy (OR, 0.88, 95 percent CI, 0.54–1.41), 14-day mortality (OR, 0.95, 95 percent CI, 0.56-1.61), and 28-day mortality (OR, 0.79, 95 percent CI, 0.48–1.29).

However, the ICI group had lower rates of COVID-19-related hospitalization (OR, 0.37, 95 percent CI, 0.21–0.67) and oxygen therapy (OR, 0.51, 95 percent CI, 0.31–0.83), and were less likely to develop complications (OR, 0.57, 95 percent CI, 0.36–0.92).