Determinants of Severity in Cancer Patients with COVID-19 Illness

New York State had 180,458 cases of SARS-CoV-2 and 9385 reported deaths as of April 10th, 2020. Patients with cancer comprised 8.4% of deceased individuals[1][1]. Population-based studies from China and Italy suggested a higher COVID-19 death rate in patients with cancer[2][2],[3][3], although there is a knowledge gap as to which aspects of cancer and its treatment confer risk of severe COVID-19 disease[4][4]. This information is critical to balance the competing safety considerations of reducing SARS-CoV-2 exposure and cancer treatment continuation. Since March 10th, 2020 Memorial Sloan Kettering Cancer Center (MSKCC) performed diagnostic testing for SARS-CoV-2 in symptomatic patients. Overall, 40% out of 423 patients with cancer were hospitalized for COVID-19 illness, 20% developed severe respiratory illness, including 9% that required mechanical ventilation, and 9% that died. On multivariate analysis, age ≥ 65 years and treatment with immune checkpoint inhibitors (ICI) within 90 days were predictors for hospitalization and severe disease, while receipt of chemotherapy within 30 days and major surgery were not. Overall, COVID-19 illness is associated with higher rates of hospitalization and severe outcomes in patients with cancer. Association between ICI and COVID-19 outcomes will need interrogation in tumor-specific cohorts. ### Competing Interest Statement All authors have completed the ICMJE uniform disclosure form at [www.icmje.org/coi_disclosure.pdf][5] and declare: no support from any organisation for the submitted work. MSG has received reports personal fees and other from Vedanta Biosciences, personal fees from Takeda, outside the submitted work. TMH has received fees for serving on scientific advisory boards for Merck & Co. and Partner Therapeutics, outside of submitted work. GAP reports grants, personal fees and other from Merck &Co, other from Takeda, other from Adma, other from Octapharma, grants and other from Chimerix, other from Partner Therapeutics, grants and other from Astellas Pharma, other from Pulmotect, outside the submitted work. JDW was a consultant for: Adaptive Biotech; Amgen; Apricity; Ascentage Pharma; Astellas; AstraZeneca; Bayer; Beigene; Bristol Myers Squibb; Celgene; Chugai; Eli Lilly; Elucida; F Star; Imvaq; Janssen; Kyowa Hakko Kirin; Linneaus; Merck; Neon Therapuetics; Novaritis; Polynoma; Psioxus; Recepta; Takara Bio; Trieza; Truvax; Serametrix; Surface Oncology; Syndax; Syntalogic; received research support from: Bristol Myers Squibb; AstraZeneca; Sephora; had equity in: Tizona Pharmaceuticals; Adaptive Biotechnologies; Imvaq; Beigene; Linneaus. All competing interests are outside of submitted work. ### Funding Statement Supported by the Memorial Sloan Kettering Cancer Center core grant (P30 CA008748), the Burroughs Wellcome Fund Investigator in the Pathogenesis of Infectious Diseases Award (TMH), the Ludwig Collaborative and Swim Across America Laboratory (JDW), the Parker Institute for Cancer Immunotherapy (JDW), Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data reported in the manuscript will be made available upon request from the corresponding author following editorial acceptance in a peer-reviewed journal. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: https://www.icmje.org/coi_disclosure.pdf