COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Etiology Wang B, Huang Y Immunotherapy or other anti-cancer treatments and risk of exacerbation and mortality in cancer patients with COVID-19: a systematic review and meta-analysis. Oncoimmunology. 2020 Sep 22;9(1):1824646. doi: 10.1080/2162402X.2020.1824646.

Background: This study was designed to investigate whether COVID-19 patients with recently received immunotherapy or other anti-cancer treatments had more severe symptoms and higher mortality.

Methods: A literature search was performed using the electronic platforms to obtain relevant research studies published up to June 28, 2020. Odds ratio (OR) and 95% confidence intervals (CI) of research endpoints in each study were calculated and merged. Statistical analyses were performed with Stata 12.0 (Stata Corp LP, College Station, TX).

Results: A total of 17 studies comprising 3581 cancer patients with COVID-19 were included in this meta-analysis. SARS-CoV-2-infected cancer patients who recently received anti-cancer treatment did not observe a higher risk of exacerbation and mortality (All p-value >0.05). We also found that surgery, targeted therapy, chemotherapy, immunotherapy, and radiotherapy were not associated with increased risk of exacerbation and mortality (All p-value >0.05). Chemotherapy within 28 d increased the risk of death events (OR 1.45, 95% CI 1.10-1.91, P = .008, p-value = 0.015 for test of interaction), and immunotherapy within 90 d increased the risk of exacerbation (OR 2.53,95%1.30-4.91, P = .006, p-value = 0.170 for test of interaction).

Conclusion: Cancer patients recently under anti-cancer treatment before diagnosed with COVID-19, including surgery, targeted therapy, immunotherapy, and radiotherapy, were not associated with increased risk of exacerbation and mortality. Chemotherapy within 28 d increased the risk of mortality, and chemotherapy was not associated with increased risk of severe COVID-19. The role of anti-cancer therapy in cancer patients with COVID-19 still needs further exploration, especially chemotherapy and immunotherapy.

Discipline / Specialty Area Score
Oncology - Breast
Oncology - Gastrointestinal
Oncology - Radiation
Oncology - Genitourinary
Oncology - Hematology
Oncology - Gynecology
Oncology - Lung
Oncology - General
Comments from MORE raters

Oncology - Breast rater

As a Radiation Oncologist, I find it's a vindication that Radiation therapy does not increase Covid-19 associated mortality. However, chemotherapy or immunotherapy within 28 days has an adverse effect on the patients affected with COVID-19. Further research is needed to find out the co-relation, if any, between excess mortality due to treatment in cancers during the Covid-19 pandemic.

Oncology - General rater

I am not sure about the value of all retrospective studies, except for 2. I don't believe this information is very useful in terms decision making.

Oncology - General rater

I suggest the authors read "Cytokine storm" NEJM last month as it points to a counterintuitive result.

Oncology - Genitourinary rater

As a urologist, I find this article provides information about a surgery plan for the pandemic but this article is more useful for oncologists.

Oncology - Gynecology rater

Selection bias?? Maybe all the really sick ones were not involved. It's reassuring to some degree but I interpret this very cautiously.

Oncology - Gynecology rater

This is an interesting article in the field of anticancer treatment and COVID infection. In my opinion, the study group is quite heterogeneous and consists of different patient populations. I think a study with more homogenous and more directed groups (only surgery or only targeted therapy or only chemo) would have been more useful and meaningful.

Oncology - Hematology rater

This is a poorly done analysis. There is a lot of bias.

Oncology - Radiation rater

Perhaps a measure of reassurance. Hardly certainty.