Immunotherapy or other anti-cancer treatments and risk of exacerbation and mortality in cancer patients with COVID-19: a systematic review and meta-analysis

Figures & data

Figure 1. PRISMA flow diagram of the meta-analysis.

Table 1. Main characteristics of the included studies in meta-analysis.

Study	Year	Country	Sample	Male	Median (IQR)	Study type	Outcomes		Time interval between recent anti-cancer treatment and diagnosis of COVID-19	NOS
					/Mean age (years)		Non-severe (survivor)	Severe (death)
J.Ma	2020	China	37	20	62.0(11.0)	Retrospective	17	20	30 d	8
L.Zhang	2020	China	28	17	65.0(56.0–70.0)	Retrospective	13	15	14 d; 30 d;	7
M.Dai	2020	China	105	57	64.0(14.0)	Retrospective	65	40	40 d	8
V.Mehta	2020	USA	218	127	69.0(10.0–92.0)	Retrospective	157	61	30 d	8
F.Yang	2020	China	52	28	63.0(34.0–98.0)	Retrospective	33	19	30 d	8
K.Yang	2020	China	205	100	63.0(14.0–96.0)	Retrospective	165	40	4 weeks	8
H. Zhang	2020	China	107	60	66.0(37.0–98.0)	Retrospective	51	56	0	8
N.Kuderer	2020	USA	928	468	66.0 (57.0–76.0)	Retrospective	807	121	4 weeks	8
E.Stroppa	2020	Italy	25	20	71.6(50.0–84.0)	Retrospective	16	9	0	8
R.Yarza	2020	Spain	63	29	66.0(63.4–68.8)	Retrospective	47	16	4 weeks	9
F.Martín	2020	Spain	34	15	72.5 (35.0–94.0)	Retrospective	23	11	0	7
L.Lee	2020	USA	800	449	69.0(59.0–76.0)	Prospective	412	226	4 weeks	9
J.Tian	2020	China	232	119	64.0(58.0–69.0)	Retrospective	84	148	1 weeks; 1–2 weeks; 2–3 weeks; >3 weeks;	9
M.Garassino	2020	Italy	200	141	68.0(61.8–75.0)	Prospective	125	66	0	9
E.Robilotti	2020	USA	423	212	NA	Retrospective	372	51	30 d;90 d#	8
S.Assaad	2020	France	55	144	63.8	Retrospective	8	47	30 d	8
J.Luo	2020	USA	69	36	69.0 (31.0–91.0)	Retrospective	41	24	42 d; 90 d; 180 d	8

Abbreviation: NOS, Newcastle–Ottawa Scale; #: Immunotherapy within 90 d.

Figure 2. Relationship between anti-cancer therapy and the risk of exacerbation and mortality in cancer patients with COVID-19.

Table 2. The results of meta-analysis.

	No.of studies	OR (95%CI)	P-value	Heterogeneity		Model used	Begg’s test	Egger’s test	P-value of interaction test
				I2	Ph
Severe events
Anti-cancer therapy	6	1.54 (0.96–2.49)	0.074	22.3%	0.266	Fixed	0.707	0.791
Surgery#	4	1.01 (0.35–2.87)	0.986	63.3%	0.043	Random	NA	NA
Chemotherapy	7	0.91 (0.67–1.24)	0.555	23.7%	0.248	Fixed	0.764	0.658	0.168
Within 28 d	4	0.66 (0.38–1.15)	0.146	49.5%	0.114	Fixed	NA	NA
Within 40 d	3	1.05 (0.73–1.50)	0.807	0	0.953	Fixed	0.624	0.534
Targetedtherapy	1	0.17 (0.01–3.22)	0.229	NA	NA	NA	NA	NA
Radiotherapy	1	0.45 (0.11–1.73)	0.243	NA	NA	NA	NA	NA
Immunotherapy	8	1.54 (0.98–2.43)	0.061	14.9%	0.313	Fixed	0.368	0.144	0.170
Within 28 d	2	0.56 (0.15–2.03)	0.376	0	0.355	Fixed	NA	NA
Within 42 d	3	1.18 (0.45–3.07)	0.734	7.30%	0.340	Fixed	NA	NA
Within 90 d	2	2.53 (1.30–4.91)	0.006	0	0.664	Fixed	NA	NA
Within 180 d	1	1.20 (0.41–3.48)	0.738	NA	NA	Fixed	NA	NA
Death events
Anti-cancer therapy	9	1.33 (0.84–2.10)	0.229	68.3%	0.001	Random	0.754	0.284
Surgery	4	1.17 (0.65–2.08)	0.604	0	0.488	Fixed	NA	NA	0.275
Within 28 d	3	1.04 (0.56–1.92)	0.902	0	0.539	Fixed	NA	NA
Within 40 d	1	2.90 (0.51–16.34)	0.229	NA	NA	NA	NA	NA
Chemotherapy	9	1.28 (0.99–1.66)	0.056	40.6%	0.096	Fixed	0.754	0.810	0.015*
Within 28 d	6	1.45 (1.10–1.91)	0.008*	6.5%	0.375	Fixed	0.573	0.220
Within 40 d	3	0.56 (0.27–1.13)	0.105	0.1%	0.367	Fixed	NA	NA
Targetedtherapy	5	1.16 (0.72–1.85)	0.546	43.4%	0.132	Fixed	0.806	0.673	0.545
Within 28 d	3	1.52 (0.55–4.16)	0.417	71.0%	0.032	Random	NA	NA
Within 40 d	2	0.81 (0.14–4.84)	0.820	0	0.990	Fixed	NA	NA
Radiotherapy	4	0.81 (0.53–1.23)	0.317	0	0.518	Fixed	NA	NA	0.545
Within 28 d	2	0.89 (0.53–1.49)	0.615	47.6%	0.167	Fixed	NA	NA
Within 40 d	2	0.68 (0.34–1.38)	0.284	0	0.916	Fixed	NA	NA
Immunotherapy	11	1.00 (0.65–1.53)	0.983	16.3%	0.289	Fixed	0.436	0.976	0.690
Within 28 d	5	0.81 (0.47–1.42)	0.463	48.2%	0.103	Fixed	0.624	0.787
Within 42 d	4	1.20 (0.47–3.10)	0.705	0	0.430	Fixed	NA	NA
Within 90 d	1	1.38 (0.28–6.92)	0.694	NA	NA	Fixed	NA	NA
Within 180 d	1	1.67 (0.47–5.90)	0.427	NA	NA	Fixed	NA	NA

Abbreviation: NA: not available; #: All within 40 d; *: P < 0.05.

Figure 3. Relationship between different anti-cancer treatments and the risk of exacerbation in cancer patients with COVID-19.

Figure 4. Relationship between different anti-cancer treatments and the risk of death events in cancer patients with COVID-19.