Cancer immunotherapy does not increase the risk of death by COVID-19 in melanoma patients


Maria Gonzalez-Cao, Monica Antonazas-Basa, Teresa Puertolas, Eva Munoz-Couselo, Jose Luis Manzano, Cristina Carrera, Ivan Marquez-Rodas, Pilar Lopez-Criado, Juan Francisco Rodriguez-Moreno, Almudena Garcia-Castano, Juan Martin-Liberal, Pedro Rodriguez-Jimenez, Susana Puig, Pablo Cerezuela, Marta Feito-Rodriguez, Belen Rubio-Viqueira, Guillermo Crespo, Pablo Luna-Fra, Cristina Aguayo, Pablo Ayala de Miguel, Rosa Feltes, Lara Valles, Ana Drozdowskyj, Ainara Soria, Cayetana Maldonado, Luis Fernandez-Morales, Rafael Rosell, Mariano Provencio, Alfonso Berrocal

Background: Covid-19 pandemic by the new coronavirus SARS-Cov-2 has produced
devastating effects on the health care system, affecting also cancer patient care. Data about
COVID-19 infection in cancer patients are scarce, and they point out a higher risk of
complications due to the viral infection in this population. Moreover, cancer treatments could
increase viral complications, specially those treatments based on the use of immunotherapy with
checkpoints antibodies. There are no clinical data about the safety of immune check point
antibodies in cancer patients when they become infected by SARS-CoV-2. As checkpoint
inhibitors, mainly anti PD-1 and anti CTLA-4 antibodies, are an effective treatment for most
melanoma patients, avoiding their use during the pandemic could lead to a decrease in the
chances of curing melanoma.

Methods: In Spain we have started a national registry of melanoma patients infected by SARSCov-2 since April 1st, 2020. A retrospective analysis of patients included in the Spanish
registery has been performed weekly since the activation of the study. Interim analysis shows
unexpected findings about cancer treatment safety in SARS-Cov-2 infected melanoma patients,
so a rapid communication to the scientific community is mandatory

Results: Fifty patients have been included as of May 17th, 2020. Median age is 69 years (range
6 to 94 years), 27 (54%) patients are males and 36 (70%) patients have stage IV melanoma.
Twenty-two (44%) patients were on active anticancer treatment with anti PD-1 antibodies, 16
(32%) patients were on treatment with BRAF plus MEK inhibitors and 12 (24%) patients were
not on active cancer treatment. COVID-19 episode has been resolved in 43 cases, including 30
(70%) patients cured, four (9%) patients that have died due to melanoma progression, and nine
(21%) patients that have died from COVID-19. Mortality rates from COVID-19 according to
melanoma treatment type were 16%, 15% and 36% for patients on immunotherapy, targeted
drugs, and for those that were not undergoing active cancer treatment, respectively.

Conclusion: These preliminary findings show that the risk of death in those patients under
going treatment with anti PD-1 antibodies does not exceed the global risk of death in this
population. These results could be relevant in order to select melanoma therapy during the
COVID-19 pandemic.

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