{"doi":"10.1101/2020.08.11.20145458","title":"Oncologic Immunomodulatory Agents in Patients with Cancer and COVID-19","abstract":"Abstract Background Corticosteroids, anti-CD20 agents, immunotherapies, and cytotoxic chemotherapy are commonly used in the treatment of patients with cancer. How these agents impact patients with cancer who are infected with SARS-CoV-2 remains unclear. Methods We retrospectively investigated associations between SARS-CoV-2-associated respiratory failure or death with receipt of the aforementioned medications and with pre-COVID-19 neutropenia. The study included all cancer patients diagnosed with SARS-CoV-2 at Memorial Sloan Kettering Cancer Center until June 2, 2020 (N=820). We controlled for cancer-related characteristics known to predispose to worse COVID-19. To address that more acutely ill patients receive therapeutic corticosteroids, we examined patient subsets based on different levels of respiratory support: ≤2 L/min supplemental oxygen, >2L/min supplemental oxygen, and advanced respiratory support prior to death. Results Corticosteroid administration was associated with worse outcomes in the pre-2L supplemental oxygen cohort; no statistically significant difference was observed in the >2L/min supplemental oxygen and post-critical cohorts. Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were lower, and ferritin levels were higher, after corticosteroid administration. In patients with metastatic thoracic cancer, 9 of 25 (36%) and 10 of 31 (32%) had respiratory failure or death among those who did and did not receive immunotherapy, respectively. Seven of 23 (30%) and 52 of 187 (28%) patients with hematologic cancer had respiratory failure or death among those who did and did not receive anti-CD20 therapy, respectively. Chemotherapy itself was not associated with worse outcomes, but pre-COVID-19 neutropenia was associated with worse COVID-19 course. Relative prevalence of chemotherapy-associated neutropenia in previous studies may account for different conclusions regarding the risks of chemotherapy in patients with COVID-19. In the absence of prospective studies and evidence-based guidelines, our data may aid providers looking to assess the risks and benefits of these agents in caring for cancer patients in the COVID-19 era.","journal":"medRxiv","year":2020,"id":125257,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9506,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":571123,"name":"Aaron J. Stonestrom","orcid":"0000-0002-0602-1158","position":1,"is_corresponding":false},{"id":90690,"name":"Sean M. Devlin","orcid":"0000-0002-6801-720X","position":2,"is_corresponding":false},{"id":571903,"name":"Teresa Nguyentran","orcid":null,"position":3,"is_corresponding":false},{"id":571904,"name":"Beatriz Wills","orcid":null,"position":4,"is_corresponding":false},{"id":571124,"name":"Varun Narendra","orcid":"0000-0001-8970-5135","position":5,"is_corresponding":false},{"id":421863,"name":"Michael B. Foote","orcid":"0000-0003-3027-2405","position":6,"is_corresponding":false},{"id":304465,"name":"Melissa Lumish","orcid":"0000-0003-4173-5567","position":7,"is_corresponding":false},{"id":78951,"name":"Santosha A. Vardhana","orcid":"0000-0002-3100-1298","position":8,"is_corresponding":false},{"id":326211,"name":"Stephen M. Pastores","orcid":"0000-0002-8850-7062","position":9,"is_corresponding":false},{"id":298171,"name":"Neha Korde","orcid":"0000-0002-5538-4318","position":10,"is_corresponding":false},{"id":571125,"name":"Dhwani Patel","orcid":"0000-0003-0566-4773","position":11,"is_corresponding":false},{"id":246207,"name":"Steven M. Horwitz","orcid":"0000-0002-6399-2006","position":12,"is_corresponding":false},{"id":108867,"name":"Michael Scordo","orcid":"0000-0002-9484-0240","position":13,"is_corresponding":false},{"id":268587,"name":"Anthony F. Daniyan","orcid":"0009-0002-2742-2281","position":14,"is_corresponding":false},{"id":428194,"name":"Justin Jee","orcid":"0000-0001-9783-0139","position":0,"is_corresponding":true}],"reference_count":19,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:15:15.482227Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}