Περίληψη:
Background As management and prevention strategies against COVID-19 evolve, it is still uncertain whether prior exposure to immune checkpoint inhibitors (ICIs) affects COVID-19 severity in patients with cancer. Methods In a joint analysis of ICI recipients from OnCovid (NCT04393974) and European Society for Medical Oncology (ESMO) CoCARE registries, we assessed severity and mortality from SARS-CoV-2 in vaccinated and unvaccinated patients with cancer and explored whether prior immune-related adverse events (irAEs) influenced outcome from COVID-19. Findings The study population consisted of 240 patients diagnosed with COVID-19 between January 2020 and February 2022 exposed to ICI within 3 months prior to COVID-19 diagnosis, with a 30-day case fatality rate (CFR 30) of 23.6% (95% CI 17.8 to 30.7%). Overall, 42 (17.5%) were fully vaccinated prior to COVID-19 and experienced decreased CFR 30 (4.8% vs 28.1%, p=0.0009), hospitalization rate (27.5% vs 63.2%, p<0.0001), requirement of oxygen therapy (15.8% vs 41.5%, p=0.0030), COVID-19 complication rate (11.9% vs 34.6%, p=0.0040), with a reduced need for COVID-19-specific therapy (26.3% vs 57.9%, p=0.0004) compared with unvaccinated patients. Inverse probability of treatment weighting (IPTW)-fitted multivariable analysis, following a clustered-robust correction for the data source (OnCovid vs ESMO CoCARE), confirmed that vaccinated patients experienced a decreased risk of death at 30 days (adjusted OR, aOR 0.08, 95% CI 0.01 to 0.69). Overall, 38 patients (15.8%) experienced at least one irAE of any grade at any time prior to COVID-19, at a median time of 3.2 months (range 0.13-48.7) from COVID-19 diagnosis. IrAEs occurred independently of baseline characteristics except for primary tumor (p=0.0373) and were associated with a significantly decreased CFR 30 (10.8% vs 26.0%, p=0.0462) additionally confirmed by the IPTW-fitted multivariable analysis (aOR 0.47, 95% CI 0.33 to 0.67). Patients who experienced irAEs also presented a higher median absolute lymphocyte count at COVID-19 (1.4 vs 0.8 10 9 cells/L, p=0.0098). Conclusion Anti-SARS-CoV-2 vaccination reduces morbidity and mortality from COVID-19 in ICI recipients. History of irAEs might identify patients with pre-existing protection from COVID-19, warranting further investigation of adaptive immune determinants of protection from SARS-CoV-2. © 2022 Author(s). Published by BMJ.
Συγγραφείς:
Cortellini, A.
Dettorre, G.M.
Dafni, U.
Aguilar-Company, J.
Castelo-Branco, L.
Lambertini, M.
Gennatas, S.
Angelis, V.
Sita-Lumsden, A.
Rogado, J.
Pedrazzoli, P.
Viñal, D.
Prat, A.
Rossi, M.
Berardi, R.
Alonso-Gordoa, T.
Grisanti, S.
Dimopoulou, G.
Queirolo, P.
Pradervand, S.
Bertuzzi, A.
Bower, M.
Arnold, D.
Salazar, R.
Tucci, M.
Harrington, K.J.
Mazzoni, F.
Mukherjee, U.
Tsourti, Z.
Michielin, O.
Pommeret, F.
Brunet, J.
Vincenzi, B.
Tonini, G.
Patriarca, A.
Biello, F.
Krengli, M.
Tabernero, J.
Pentheroudakis, G.
Gennari, A.
Peters, S.
Romano, E.
Pinato, D.J.
Λέξεις-κλειδιά:
ad 26 cov 2 s; ad26.cov2.s vaccine; elasomeran; immune checkpoint inhibitor; tozinameran; vaxzevria, adult; adverse event; aged; Article; case fatality rate; coronavirus disease 2019; disease severity; female; histogram; hospitalization; human; immunotherapy; male; malignant neoplasm; mortality; mortality rate; observational study; oxygen therapy; primary tumor; prospective study; reverse transcription polymerase chain reaction; treatment outcome; vaccination; neoplasm; oncology; register, COVID-19; COVID-19 Testing; Humans; Immune Checkpoint Inhibitors; Medical Oncology; Neoplasms; Registries; SARS-CoV-2
