COVID-19: The Use of Immunotherapy in Metastatic Lung Cancer

Davis, Alexander; Boyer, Michael; Lee, Jenny; Kao, Steven

doi:10.2217/imt-2020-0096

Cited by 21 publications

(23 citation statements)

References 26 publications

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“…Accordingly, Luo et al 92 observed that PD-1 blockade exposure was not associated with increased risk of severity of COVID-19 in patients with lung cancer. 89 92 Notably, ICI may even represent an effective approach in the management of COVID-19 patients without cancer. 71 73 76 79 Additionally, a combination of ICI with an anti-IL-6 antibody is an attractive approach to reduce the risks of both irAEs and possible cytokine excess frequently observed in severe COVID-19 cases.…”

Section: Covid-19mentioning

confidence: 99%

On the use of immune checkpoint inhibitors in patients with viral infections including COVID-19

Gambichler

Reuther

Scheel

et al. 2020

J Immunother Cancer

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The present review summarizes up-to-date evidence addressing the frequently discussed clinical controversies regarding the use of immune checkpoint inhibitors (ICIs) in cancer patients with viral infections, including AIDS, hepatitis B and C, progressive multifocal leukoencephalopathy, influenza, and COVID-19. In detail, we provide available information on (1) safety regarding the risk of new infections, (2) effects on the outcome of pre-existing infections, (3) whether immunosuppressive drugs used to treat ICI-related adverse events affect the risk of infection or virulence of pre-existing infections, (4) whether the use of vaccines in ICI-treated patients is considered safe, and (5) whether there are beneficial effects of ICIs that even qualify them as a therapeutic approach for these viral infections.

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Section: Covid-19mentioning

confidence: 99%

On the use of immune checkpoint inhibitors in patients with viral infections including COVID-19

Gambichler

Reuther

Scheel

et al. 2020

J Immunother Cancer

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“…Oncology patients are considered more susceptible to SARS-CoV-2 infections due to their immunocompromised status caused by both cancer and various anti-cancer treatments such as chemotherapy, immunotherapy, and radiotherapy. [38][39][40][41] Given this, with the increasing risk of the COVID-19 pandemic, the management of oncology patients undergoing anticancer therapy must be adequately balanced. 42 Currently, there is a lack of knowledge to evaluate the risks and benefits of anticancer treatment in cancer patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Immunotherapy or other anti-cancer treatments and risk of exacerbation and mortality in cancer patients with COVID-19: a systematic review and meta-analysis

Wang

Huang

2020

OncoImmunology

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Background: This study was designed to investigate whether COVID-19 patients with recently received immunotherapy or other anti-cancer treatments had more severe symptoms and higher mortality. Methods: A literature search was performed using the electronic platforms to obtain relevant research studies published up to June 28, 2020. Odds ratio (OR) and 95% confidence intervals (CI) of research endpoints in each study were calculated and merged. Statistical analyses were performed with Stata 12.0 (Stata Corp LP, College Station, TX). Results: A total of 17 studies comprising 3581 cancer patients with COVID-19 were included in this metaanalysis. SARS-CoV-2-infected cancer patients who recently received anti-cancer treatment did not observe a higher risk of exacerbation and mortality (All p-value >0.05). We also found that surgery, targeted therapy, chemotherapy, immunotherapy, and radiotherapy were not associated with increased risk of exacerbation and mortality (All p-value >0.05). Chemotherapy within 28 d increased the risk of death events (OR 1.45, 95% CI 1.10-1.91, P = .008, p-value = 0.015 for test of interaction), and immunotherapy within 90 d increased the risk of exacerbation (OR 2.53,95%1.30-4.91, P = .006, p-value = 0.170 for test of interaction). Conclusion: Cancer patients recently under anti-cancer treatment before diagnosed with COVID-19, including surgery, targeted therapy, immunotherapy, and radiotherapy, were not associated with increased risk of exacerbation and mortality. Chemotherapy within 28 d increased the risk of mortality, and chemotherapy was not associated with increased risk of severe COVID-19. The role of anti-cancer therapy in cancer patients with COVID-19 still needs further exploration, especially chemotherapy and immunotherapy.

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“…Furthermore, alternative decisions to speci c cohorts may be adopted, e.g. early treatment discontinuation in patients with complete or prolonged response [8], adjustments of treatment interval or modality [7,43], or adjournments of ICI treatment in high risk patients (e.g. elderly, patients with history of immune-related adverse events and/or comorbidities) [43].…”

Section: Discussionmentioning

confidence: 99%

“…In light of this, the question remains whether to postpone or continue active cancer treatment, including immune checkpoint inhibitor (ICI), which exerts immunomodulatory functions [5]. To the best of our knowledge, the current evidence on the effect of prior ICI treatment on cancer patients infected with COVID-19 remains equivocal [6][7][8]. Therefore, this meta-analysis aims to explore the association between ICI and COVID-19 outcomes in cancer patients, thus providing the best available evidence to guide real-time treatment decisions in such cases.…”

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitor does not increase risks of poor outcomes in cancer patients with COVID-19 infection: A systematic review and meta-analysis

Lazarus

Budiman

Rinaldi

2020

Preprint

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Background The association between prior exposure to immune checkpoint inhibitor (ICI) and outcomes of cancer patients with coronavirus disease 2019 (COVID-19) infection has yet to be systematically evaluated. As the current evidence remains equivocal, this meta-analysis aims to investigate the effects of ICI treatment on COVID-19 prognosis, including mortality, severity, and hospitalization.Methods Eligible studies published up to 14 September 2020 were included and assessed for risk of bias using the Quality in Prognosis Studies tool. A random-effects meta-analysis was conducted to estimate the pooled effect size along with 95% confidence intervals (CIs). The quality of body evidence was evaluated using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.Results Six studies involving a total of 1647 COVID-19-infected cancer patients were included in the systematic review. We discovered that prior ICI exposure was not associated with COVID-19 mortality (odds ratio [OR] 0.93 [95% CI: 0.37-2.36]; I2=30%), severity (OR 1.15 [95% CI: 0.40-3.28]; I2=0%), and hospitalization (OR 1.35 [95% CI: 0.64-2.87]; I2=51%). However, we discovered that prior exposure to chemoimmunotherapy predicted COVID-19 severity (OR 8.19 [95% CI: 2.67-25.08]; I2=0%), albeit with small sample size. GRADE assessments resulted in moderate-quality evidence for mortality, while the other outcomes yielded very low-to-low-quality evidenceConclusion Our findings indicated that ICI treatment should not be adjourned nor terminated during the current pandemic. Rather, COVID-19 vigilance should be increased, especially in patients receiving chemoimmunotherapy. Further studies with larger ICI cohorts are required to confirm our findingsTrial registration number: This project has been prospectively registered at PROSPERO (registration ID: CRD42020202142) on 4 August 2020.

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COVID-19: The Use of Immunotherapy in Metastatic Lung Cancer

Cited by 21 publications

References 26 publications

On the use of immune checkpoint inhibitors in patients with viral infections including COVID-19

On the use of immune checkpoint inhibitors in patients with viral infections including COVID-19

Immunotherapy or other anti-cancer treatments and risk of exacerbation and mortality in cancer patients with COVID-19: a systematic review and meta-analysis

Immune checkpoint inhibitor does not increase risks of poor outcomes in cancer patients with COVID-19 infection: A systematic review and meta-analysis

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