A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19

Abstract

Background: The COVID-19 pandemic hit all over the world, and cancer patients are more vulnerable for COVID-19. The mortality rate may increase up to 25% in solid malignancies. In parallel to increased mortality rates among cancer patients, safety concerns regarding cancer treatment has increased over time. However, there were contradictory results for the cancer treatment during pandemic. In this study, we assessed the effect of cancer treatment on the severity of COVID-19.

Methods: The MEDLINE database was searched on September 01, 2020. Primary end-points were severe disease and death in the cancer patients treated within the last 30 days before COVID-19 diagnosis. Quality of included studies was assessed by Newcastle-Ottawa scale. The generic inverse-variance method was used to calculate odds ratios (ORs) for each outcome.

Results: Sixteen studies were included for this meta-analysis. Chemotherapy within the last thirty days before COVID-19 diagnosis increased the risk of death in cancer patients after adjusting for confounding variables (OR: 1.85; 95% confidence interval: 1.26-2.71). However, severe COVID-19 risk did not increase. Furthermore, targeted therapies, immunotherapy, surgery and radiotherapy did not increase the severe disease and death risk in cancer patients with COVID-19.

Conclusion: Chemotherapy increased the risk of death from COVID-19 in cancer patients. However, there was no safety concern for immunotherapy, targeted therapies, surgery and radiotherapy.

Keywords: COVID-19; Cancer treatment; Chemotherapy; Immunotherapy; SARS-CoV-2; Targeted therapy.

Fig. 1

The PRISMA diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig. 2

(a) The forest plot of unadjusted severe COVID-19 risk due to chemotherapy. (b) The forest plot of unadjusted risk of death from COVID-19 due to Chemotherapy. (c) The forest plot of adjusted severe COVID-19 risk due to chemotherapy. ∗Adjusted variables for the study of Jee et al. [21]: age, BMI, sex, performance score, smoking, comorbidities, malignancy type, cancer remission status, neutropenia and lymphopenia. ∗Adjusted variables for the study of Yarza et al. [19]: age, sex, performance score, presence of metastasis, previous venous thromboembolic event, chronic obstructive pulmonary disease. (d) The forest plot of adjusted risk of death from COVID-19 due to chemotherapy. ∗ Adjusted variables for the study of Kuderer et al. [7]: age, sex, smoking status and obesity. ∗ Adjusted variables for the study of Lee et al. [8]: cancer treatment subtype. ∗ Adjusted variables for the study of Yang et al. [16]: sex, cancer type, duration of cancer diagnosis. ∗ Adjusted Variables for the study of Yarza et al. [19]: age, sex, performance score, presence of metastasis, previous venous thromboembolic event, chronic obstructive pulmonary disease. CI, confidence interval; IV, inverse variance; SE, standard error.

Fig. 3

(a) The forest plot of unadjusted severe COVID-19 Risk Due to Immunotherapy. (b) The forest plot of unadjusted risk of death from COVID-19 due to immunotherapy. (c) The forest plot of adjusted severe COVID-19 risk due to immunotherapy. ∗Adjusted variables for the study of Robilotti et al.: age, race, smoking, asthma, cancer type, comorbidities, corticosteroid use/lymphopenia. ∗ Adjusted variables for the study of Yarza et al.: age, sex, performance score, presence of metastasis, previous venous thromboembolic event, chronic obstructive pulmonary disease. CI, confidence interval; IV, inverse variance; SE, standard error.

Fig. 4

(a) The forest plot of unadjusted severe COVID-19 risk due to targeted therapy. (b) The forest plot of unadjusted risk of death from COVID-19 due to targeted therapy. CI, confidence interval; IV, inverse variance; SE, standard error.

Fig. 5

(a) The forest plot of unadjusted severe COVID-19 risk due to surgery. (b) The forest plot of unadjusted risk of death from COVID-19 due to surgery. CI, confidence interval; IV, inverse variance; SE, standard error.

Fig. 6

The forest plot of unadjusted risk of death from COVID-19 due to radiotherapy. IV, inverse variance; SE, standard error

Fig. 7

(a) The forest plot of unadjusted severe COVID-19 risk due to cancer treatment. (b) The forest plot of unadjusted risk of death from COVID-19 due to cancer treatment. CI, confidence interval; IV, inverse variance; SE, standard error.