Impact of anti-cancer therapy on disease severity and mortality in cancer patients with COVID-19: a systematic review and meta-analysis

ABSTRACT

Background: Coronavirus disease-2019 (COVID-19) poses a serious health threat to people around the world, particularly in patients with cancer. Whether or not cancer patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) receive anti-cancer therapy is associated with a poor prognosis is unclear. This systematic review and meta-analysis aims to assess whether anti-cancer therapies such as surgery, chemotherapy, immunotherapy, and targeted therapy will increase the severity and mortality of cancer patients with COVID-19.

Methods: A comprehensive search was conducted on PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI). The search timeperiod was from 1st of December 2019 to 23rd of January 2021, to identify observational studies that compared the disease severity and mortality of COVID-19 patients receiving and not receiving anti-cancer therapy. Two independent reviewers used the Newcastle-Ottawa Scale to evaluate the quality of the included studies. Data were input into the selected studies, meta-analysis was conducted using Revman 5.3 statistical software, and publication bias was analyzed.

Results: A total of 26 studies were included in this meta-analysis, involving 5571 cancer patients infected with SARS-CoV-2. Results showed that surgery, chemotherapy, immunotherapy and targeted therapy were not associated with disease severity or mortality (107/688, OR =1.30, 95% CI[0.79, 2.13], P =0.30, I2 =38%; 1956/2674, OR =1.27, 95% CI [0.95, 1.69], P =0.10, I2 =65%; 342/1455, OR =1.20, 95% CI [0.90, 1.61], P =0.21, I2 =7%; 503/1378, OR =0.92, 95% CI [0.72, 1.19], P =0.54, I2 =0%, respectively).

Conclusion: In cancer patients with COVID-19, anti-cancer therapy had no adverse effect on disease severity and mortality. Further research is necessary to determine the complex interrelationship between anti-cancer therapy, particularly chemotherapy, and COVID-19.