Thirty-Day Mortality Among Patients with SARS-CoV-2 Infection Undergoing Active Antitumoral Therapy

Abstract

Background: Coronavirus Disease 2019 (COVID-19),the disease related to the novel respiratory pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the first major pandemic of the 21stCentury. Early studies have examined COVID-19 outcomes among cancer patients but factors affecting mortality in this population remain unclear. The purpose of this study is to determine whether immunotherapy affects mortality rates in cancer patients undergoing active antitumoral therapy when compared to cytotoxic chemotherapy alone. Methods: This is a retrospective study of cancer patients who tested positive for SARS-CoV-2 virus between March 2020 and May 2020 at a tertiary care cancer center in New York City. Patients who tested positive for the virus were identified from an institutional registry. Subjects were identified by their active antitumoral treatment status, then further delineated by whether they recently received chemotherapy, immunotherapy, or both. Cancer type was identified by ICD-10 codes. Immunotherapy was defined as therapy that modulates immunity to treat cancer. Analyses (cross-tabulation) were performed to compare the thirty-day mortality rates between patients receiving cytotoxic chemotherapy and those receiving immunotherapy (either as monotherapy or combined with other chemotherapy). Thirty-day mortality was defined as death within 30 days of SARS-CoV-2 detection. Results: Among the 1770 cancer patients identified who tested positive for SARS-Cov-2, 48% (n=848) were men and the average age was 61 years old. 38.0% of these patients (n=671) received active antitumoral therapy within 6 months prior to viral detection. Within this cohort, 598 patients received chemotherapy only and 73 patients received either immunotherapy alone or in combination with chemotherapy. The thirty-day mortality was 8.0% (n=48) in the subgroup receiving chemotherapy and 19.2% (n=14) in the subgroup who received immunotherapy as part of their treatment regimen. The odds of thirty-day mortality in the group who received immunotherapy as part of their treatment regimen was 2.7 times greater than that of chemotherapy alone (OR 2.7, 95% CI [1.4,5.2]). Conclusion: This study suggests that short-term mortality among patients receiving immunotherapy as part of cancer treatment may be higher than among those who receive chemotherapy alone. These results have the potential for significant clinical impact in the treatment of patients with active cancer, as they may suggest an added risk of immunotherapy in those positive for SARS-CoV-2. Further directions of study will assess for possible confounders, the effect of immunotherapy on mortality among different types of cancer, and other factors affecting mortality in this population.