Clinical Outcomes after Immunotherapies in Cancer Setting during COVID-19 Era: A Systematic Review and Meta-Regression

Round 1

Reviewer 1 Report

In the manuscript “Clinical outcomes after immunotherapies for cancer patients
during COVID-19 era: a systematic review”, the authors stated that Cancer patients could be more susceptible to COVID-19 infection because of their vulnerable immunity status due to the cancer itself and cancer treatment. The authors stated that the duration of the pandemic and the trajectory of COVID-19 infection are still unknown and unpredictable, we undertook a systematic review to obtain solid data showing patient characteristics and COVID-19–related outcomes after ICIs during the COVID-19 era. Care providers need these data to create effective, tolerable ICI treatment plans without compromising safety or outcomes. The authors employed the methodology like literature search including the Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed, and Wiley-Blackwell Cochrane Library databases for publications in the English language from December 1, 2019, to October 15, 2020. The authors evaluated and chose some studies and extracted data and end points. The end points including the primary endpoint of the analysis was COVID-19–related mortality. Secondary endpoints included COVID-19–related therapy, readmission to the hospital, ER visits, opportunistic infections, respiratory complications, need for ventilation, need for tracheostomy, and thrombo-embolic events.

-The results are based on the presented data.

-Authors need to mention the objectives of the study clearly at the end of the introduction section.

-Revise the title

-Compare and contrast your finding with some previous studies in discussion section.

-The study is well written and designed. Check the manuscript for minor spelling mistakes and formatting errors.

 

 

Author Response

Point 1. In the manuscript “Clinical outcomes after immunotherapies for cancer patients during COVID-19 era: a systematic review”, the authors stated that Cancer patients could be more susceptible to COVID-19 infection because of their vulnerable immunity status due to the cancer itself and cancer treatment. The authors stated that the duration of the pandemic and the trajectory of COVID-19 infection are still unknown and unpredictable, we undertook a systematic review to obtain solid data showing patient characteristics and COVID-19–related outcomes after ICIs during the COVID-19 era. Care providers need these data to create effective, tolerable ICI treatment plans without compromising safety or outcomes. The authors employed the methodology like literature search including the Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed, and Wiley-Blackwell Cochrane Library databases for publications in the English language from December 1, 2019, to October 15, 2020. The authors evaluated and chose some studies and extracted data and end points. The end points including the primary endpoint of the analysis was COVID-19–related mortality. Secondary endpoints included COVID-19–related therapy, readmission to the hospital, ER visits, opportunistic infections, respiratory complications, need for ventilation, need for tracheostomy, and thrombo-embolic events.

Response 2. Thank you so much for the positive feedback. We are glad to provide valuable information to help the physicians in our journey of fitting COVID-19.

Point 2. The results are based on the presented data.

Response 2. Yes, we were ken on how to present the data. Our target was to provide the maximum data available.

Point 3. Authors need to mention the objectives of the study clearly at the end of the introduction section.

Response 3. We appreciate the reviewer’s suggestion. We have clarified the objectives at the end of the introduction section. We added “The objective of this systematic review was to address the clinical outcomes after ICIs for cancer patients during the COVID-19 era. The primary endpoint was COVID-19–related mortality and the secondary endpoints included COVID-19–related therapy, readmission to the hospital, ER visits, opportunistic infections, respiratory complications, need for ventilation, need for tracheostomy, and thrombo-embolic events”.

Point 4. Revise the title

Response 4. We thank the reviewer for his suggestion. The title has been revised to “Clinical outcomes after immunotherapies in cancer setting during COVID-19 era: a systematic review and meta-regression”

Point 5. Compare and contrast your finding with some previous studies in discussion section.

Response 5. We appreciate the reviewer’s comment. We have compared our data with the previous studies. That was a little challenging considering the scanty data available that address the outcomes in such a unique population. We have added more references in the revised draft.

Point 6. The study is well written and designed. Check the manuscript for minor spelling mistakes and formatting errors.

 Response 6. We thank the reviewer for the comment. We have checked for minor spelling mistakes and formatting errors.

Author Response File: Author Response.pdf

Reviewer 2 Report

It is an interesting topic.

I think that the primary endpoint should be mortality in cancer and concurrent covid-19 infection. 

Immunotherapy is frequently associated with a risk of pneumonia so it is not clear if mortality is more influenced by immunotherapy-related pneumonia and respiratory failure or it is due to complicated covid-19 infection.

Please provide information about comorbidities of patients included , specify what prevalent type of neoplasm was examined, mean pack-years and staging at the time of covid infection

I suggest to include the following references to widen the discussion:

-  J Virol Methods. 2022 Feb;300:114419. doi:10.1016/j.jviromet.2021.114419.

-J Med Virol. 2021 Mar;93(3):1239-1241. doi: 10.1002/jmv.26585.

-Adv Respir Med. 2022;90(3):219-229. doi: 10.5603/ARM.84782. 

Author Response

Point 1. It is an interesting topic.

Response 1. We thank the reviewer for the positive feedback.

Point 2. I think that the primary endpoint should be mortality in cancer and concurrent covid-19 infection. 

Response 2. We appreciate the reviewer's suggestion. The primary endpoint was COVID-19–related mortality. We have clarified that at the end of the introduction section.

Point 3. Immunotherapy is frequently associated with a risk of pneumonia so it is not clear if mortality is more influenced by immunotherapy-related pneumonia and respiratory failure or it is due to complicated covid-19 infection.

Response 3. We agree with the reviewer regarding the complexity when it comes to lung injury after immunotherapies especially in cancer patients and particularly during the COVID-19 pandemic. We have discussed this challenge in the discussion section.

Point 4. Please provide information about comorbidities of patients included , specify what prevalent type of neoplasm was examined, mean pack-years and staging at the time of covid infection.

Response 4. We appreciate the reviewer’s comment. We included the available information regarding the comorbidities in table 1. Sadly. the available data do not provide further detailed information on such a unique cohort of patients.

Point 5. I suggest to include the following references to widen the discussion:

-  J Virol Methods. 2022 Feb;300:114419. doi:10.1016/j.jviromet.2021.114419.

-J Med Virol. 2021 Mar;93(3):1239-1241. doi: 10.1002/jmv.26585.

-Adv Respir Med. 2022;90(3):219-229. doi: 10.5603/ARM.84782. 

Response 5. We appreciate the reviewer’s advice. We have added the suggested references.

Author Response File: Author Response.pdf