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Cancer patients receiving immunotherapy were at increased risk for severe outcomes from COVID-19, according to retrospective findings from Memorial Sloan Kettering Cancer Center in New York City.

Among over 400 cancer patients with symptomatic COVID-19, those treated with immune checkpoint inhibitors saw a nearly threefold risk of hospitalization (HR 2.84, 95% CI 1.24-6.72, P=0.013) and severe respiratory illness (HR 2.74, 95 CI 1.37-5.46, P=0.004) in a multivariate analysis, Mini Kamboj, MD, and colleagues from Sloan Kettering reported.

In the 35 patients with lung cancer, higher rates of hospital admission and severe respiratory illness were seen for those on immunotherapy (83% and 58%, respectively) compared to those not treated with these agents (52% and 35%). To a lesser degree, this pattern was seen among patients with other solid cancers receiving immune checkpoint inhibitors as well.

Writing in , however, they cautioned that treatment decisions regarding these anticancer agents in patients with symptomatic COVID-19 should not be altered without further evidence, and recommended increased testing to ward of potential infections in this vulnerable population.

In contrast with earlier reports, there was no increased risk of worse outcomes among patients undergoing chemotherapy within 30 days of their COVID-19 diagnosis, and major surgery and metastatic disease did not predict worse outcomes.

"If you're an oncologist and you're trying to figure out whether to give patients chemotherapy, or if you're a patient who needs treatment, these findings should be very reassuring," co-author Ying Taur, MD, PhD, said in a .

On multivariate analysis, patients with hematologic malignancies had an increased risk of hospitalization (HR 2.49, 95% CI 1.35-4.67) and potentially severe respiratory illness as well (HR 1.79, 95% CI 0.97-3.32), in line with a previous report showing higher mortality in this group.

Non-white race (HR 1.62, 95% CI 1.05-2.51) and chronic lymphopenia or corticosteroid use (HR 1.85, 95% CI 1.06-3.24) were also significantly associated with an increased risk of hospitalization.

"The course and clinical spectrum of this disease is still not fully understood and this is just one of many studies that will need to be done on the connections between cancer and COVID-19," Kamboj said in the statement. "But the big message now is clear: People shouldn't stop or postpone cancer treatment."

For their study, Kamboj, Taur, and colleagues examined 423 cancer patients diagnosed with COVID-19 at Memorial Sloan Kettering from March 10 to April 7. A majority of patients were 60 and older (56%), and older age was tied to worse outcomes. Overall, a fifth of patients developed severe respiratory illness, 9% required mechanical ventilation, and 12% died.

Hospitalization was required in 40% of patients, and 20% were admitted to the ICU. Among these hospitalized and ICU patients, respectively, 24% and 35% died.

About three-fourths of patients in the cohort had solid tumors, and breast cancer was the most common tumor type (20%), followed by lymphoma in 11%, colorectal cancer in 9%, lung cancer and leukemia in 8% each, prostate cancer in 6%, and myeloma in 5%.

Limitations noted by the authors included the single-center design, that COVID-19-directed therapies (of which patients received a number of investigational agents) were not evaluated for this analysis, and the fact that testing at the center was only directed toward symptomatic patients.

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