Immunotherapy or other anti-cancer treatments and risk of exacerbation and mortality in cancer patients with COVID-19: a systematic review and meta-analysis

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.