Outcomes of active cancer patients with COVID-19 infection treated with COVID-19 neutralizing monoclonal antibodies.

Abstract

3137 Background: Treatment with COVID-19 (C19) neutralizing monoclonal antibodies (mAbs), including bamlanivimab and casirivimab/imdevimab, has been associated with decreased rates of C19-related hospitalizations in high-risk patients. Patients with active cancer are at high-risk for C19 complications and currently are candidates for C19-mAbs. Little is known about C19-related outcomes with mAb therapy in cancer patients. Here, we examine the outcomes of a cohort of active cancer patients infected with C19 who were treated with C19-neutralizing mAbs. Methods: Retrospective, single center cohort of patients with active cancer and mild-moderate C19 infection not requiring hospitalization who were treated with either bamlanivimab or casirivimab/imdevimab. Active cancer was defined as a solid or hematologic malignancy diagnosed within 90 days of C19 diagnosis or recurrent/metastatic disease. The primary endpoint was the rate of C19-related hospitalization. Secondary endpoints included the rate of C19-related mortality and adverse events associated with mAb therapy. Results: We identified 38 active cancer patients with C19 who were treated with mAbs. Median age was 65 years (range 20-89) and 47.4% (N = 18) had a hematologic malignancy. Among the cohort, 73.7% (N = 28) were on an anti-cancer therapy at the time of C19 diagnosis: targeted therapy (n = 18), cytotoxic chemotherapy (N = 5), immunotherapy (n = 3), or hormonal therapy (n = 2). 42.1% (N = 16) received bamlanivimab and 57.9% (N = 22) received casirivimab/imdevimab. Median time from C19 diagnosis to mAb infusion was 2 days (range 0-6 days). With a median follow-up of 21 days (range 7-71), 7.9% (N = 3) required hospitalization for C19-related complications. Median time from mAb infusion to hospitalization was 25 days (range 5-29). C19-related deaths occurred in 5.3% (N = 2) of the cohort. No significant adverse events were reported with either mAb formulation. Conclusions: Among a cohort of high-risk cancer patients treated with mAbs, rates of hospitalization and mortality due to C19 were low compared to previously described rates among active cancer patients. Key limitations of this analysis include the lack of a control group for comparison and a small sample size given the recent emergency use authorization of these agents. Given the high mortality rate of active cancer patients with C19, these data support the use of mAbs in cancer patients with C19.