Alternatively, perhaps chemotherapy and certain other systemic treatments inhibit viral replication, which is in line with Hempel’s observation that many of the asymptomatic patients tested had a high PCR cycle threshold value, indicating a low viral load, she said. In addition, of 77 SARS-CoV-2–positive patients who received an antibody test 4 weeks later, only 6 had developed detectable SARS-CoV–targeting antibodies, according to a separate preprint.5 “Maybe their viral load is not high enough to [stimulate the production of] antibodies,” Hempel said.

Yet notably, a recent analysis also presented at ESMO, which investigated the association between prior cancer treatment and COVID-19 outcomes in more than 3600 patients, found that patients who had received systemic therapy within 1 to 3 months prior to COVID-19 diagnosis had higher rates of COVID-19 complications and mortality.6 That was particularly the case for those receiving combinations of chemotherapy and immunotherapy, such as B-cell–depleting anti-CD20 monoclonal antibodies. That study encompassed both hospitalized and non-hospitalized patients, including asymptomatic COVID-19 individuals with confirmed SARS-CoV-2 infections.

However, Francesco Grossi, MD, director of the division of medical oncology at the Ospedale Maggiore Policlinico of Milan, Italy, agreed it’s possible that certain immunosuppressive therapies could have a protective effect. “We have also seen that in people treated with immunosuppressant agents, we have less cases of COVID compared to the rest of the population — probably because the immune system is less reactive in [those] patients,” he said.

In data he and his colleagues recently presented at ESMO, encompassing 562 patients with cancer in Italy, the team reported that both the incidence of COVID-19 diagnosis and of antibody-positivity among patients who displayed flu-like symptoms was similar to the incidence observed in the general population.7


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Dr Grotti’s experience in Italy is broadly in line with the results presented in the German study, he said. COVID-19 outcomes are notably worse among lung cancer patients and in those with certain risk factors, Dr Grotti said. But, Dr Grotti added, “I don’t believe that patients with cancer are more at risk of COVID or COVID-related complications compared to the [general] population. . . . That’s my opinion.”

Future studies assessing more diverse groups of patients with cancer will provide a broader picture of the outcomes of COVID-19 in this patient population. “If we are testing more people, maybe that 30% [mortality over] the course of time will shrink,” Dr Pinato said. “If we broaden the picture, we’ll have a better understanding of the disease.”

References

  1. Pinato DJ, Zambelli A, Aguilar-Company J, et al. Clinical portrait of the SARS-CoV-2 epidemic in European patients with cancer. Cancer Discov. 2020;10(10). doi:10.1158/2159-8290.CD-20-0773
  2. Hempel D, Milani V, Kleespies A, et al. 1680P SARS-CoV-2 infections in outpatients with cancer: Most infected patients are asymptomatic carriers without impact on chemotherapy. Ann Oncol. 2020;31:S995. doi:10.1016/j.annonc.2020.08.1744
  3. European Society of Medical Oncology (ESMO) Virtual Congress 2020. Bringing innovation to cancer patients [press release]. Published September 14, 2020. Accessed October 6, 2020.
  4. European Society of Clinical Microbiology and Infectious Diseases. Higher risk of death in cancer patients with COVID-19 may be due to advanced age and more pre-existing conditions, rather than cancer itself [press release]. Published September 22, 2020. Accessed October 6, 2020.
  5. Hempel L, Molnar J, Robert S, et al. Rare SARS-CoV-2 antibody development in cancer patients. Research Square [preprint]. Published September 4, 2020. Accessed October 6, 2020. doi:10.21203/rs.3.rs-71560/v1
  6. Wise-Draper TM, Desai A, Elkrief A, et al. LBA71 Systemic cancer treatment-related outcomes in patients with SARS-CoV-2 infection: A CCC19 registry analysis. Ann Oncol. 2020;31:S1201–S1202. doi:10.1016/j.annonc.2020.08.2312
  7. Grossi F, Cattaneo M, Rijavec E, et al. 1696P Incidence of influenza-like illness (ILI) in cancer patients during COVID-19: The ONCOVID prospective observational study. Ann Oncol. 2020;31(4):S1001. doi:10.1016/j.annonc.2020.08.1760