Journal Article

Early mortality in patients with cancer and COVID-19 infection treated with immunotherapy

Raphael, Jacques, Lam, Melody, Le, Britney, Cheung, Matthew, Blanchette, Phillip, Singh, Simron, Trudeau, Maureen

2025

Overview

Background Immunotherapy in the presence of COVID-19 infections raises concerns because of potential overlapping clinical complications and immune system enhancement. Further investigation is warranted to establish its safety and to improve clinical decisions. Methods We conducted a retrospective cohort study using linked health administrative data from Ontario, Canada to assess 30-day mortality in patients with solid tumors who were treated with immunotherapy within 120 days before testing positive for COVID-19. A stepwise multivariable logistic regression model was used to identify clinical factors associated with 30-day mortality. Results Between January 2020 and April 2023, 281 patients tested positive for COVID-19 and were included in our study. The mean age was 68 (Standard Deviation: 10.3), 45% (127/281) were females and 58% (163/281) had lung cancer. 59% of patients (167/281) were treated with single agent immunotherapy, and almost 80% received at least one dose of COVID-19 vaccine. The 30-day mortality was 22% (63/281) and < 5% of patients were admitted to ICU or required ventilation. Factors associated with higher mortality were older age (Odds Ratio (OR) 1.60, 95% confidence interval (CI) 1.07–2.39), prior radiation therapy (OR 2.38, 95%CI 1.08–5.28), lower hemoglobin (< 10 g/dl) (OR 4.08, 95%CI 1.89–8.82) and higher leucocytes count (> 11,000/mm 3 ) (OR 3.63, 95%CI 1.55–8.52). Conclusions Immunotherapy does not seem to increase the risk of 30-day mortality in patients with COVID-19 infections compared to published outcomes of patients with cancer and COVID-19. Mortality was associated with certain clinical characteristics that need to be carefully examined when prescribing immunotherapy during future comparable pandemics.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age / Aged / Aged, 80 and over / Analysis / Apoptosis / Biomedical and Life Sciences / Biomedicine / Blood / Blood platelets / Body mass index / Cancer / Cancer patients / Cancer Research / Cancer therapies / Care and treatment / Cell death / Chemotherapy / Comorbidity / Complications and side effects / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - immunology / COVID-19 - mortality / COVID-19 diagnostic tests / COVID-19 Vaccines / Emergency medical care / Female / Health aspects / Health Promotion and Disease Prevention / Hemoglobin / Hospitals / Humans / Immune system / Immunotherapy / Immunotherapy - adverse effects / Immunotherapy - methods / Infection / Leukocytes / Lung cancer / Lymphocytes / Male / Medical diagnosis / Medical research / Medicine, Experimental / Medicine/Public Health / Middle Aged / Monoclonal antibodies / Mortality / Neoplasms - complications / Neoplasms - immunology / Neoplasms - mortality / Neoplasms - therapy / Oncology / Ontario / Ontario - epidemiology / Patient outcomes / Patients / Radiation therapy / Radiotherapy / Regression analysis / Retrospective Studies / SARS-CoV-2 / Solid tumors / Surgical Oncology / Variables / Ventilation / Ventilators