Background: Patients with cancer are vulnerable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), although the impact of solid cancer types and systemic anticancer treatments on its related mortality is still debatable. Methods: To weigh the real impact of immune-checkpoint inhibitors (ICIs) by exploring the risk of SARS-CoV-2-related mortality in a retrospective analysis of patients with non-small-cell lung cancer (NSCLC) treated with first-line Pembrolizumab or in combination with chemotherapy (ChT) during the first surge of the pandemic. Results: The risk of death was significantly higher in the group of patients treated with ChT+Pembrolizumab than with Pembrolizumab alone (OR 2.43 (1.23-4.82, p=0.01). The SARS-CoV-2-related mortality rate was 8% and significantly associated with ChT+Pembrolizumab as compared to Pembrolizumab alone (18% vs. 0%, respectively, p=0.03). Patients dead because of SARS-CoV-2 were older than 70 years (100 vs. 34%, respectively, p=0.03) and tended to have a heavier smoking history (67 vs. 29% of current smokers, respectively, p=0.17). Higher baseline values of neutrophil-to-lymphocyte ratio (NLR) (with 67 vs. 50% ≥ 4.0, p=0.58) and systemic immune-inflammation index (SII) (with 67 vs. 50% ≥ 1236, p=0.58) were observed in patients dead due to the SARS-CoV-2. Conclusions: Immunotherapy might not impact the risk of SARS-CoV-2-related mortality, whilst the addition of ChT was either associated with an overall increased risk of mortality and to the risk of SARS-CoV-2-related mortality. The co-existence of other clinical factors may have contributed to the latter.
Risk of SARS-CoV2-related Mortality in Non-small Cell Lung Cancer Patients Treated With First-line Immunotherapy Alone or in Combination With Chemotherapy