Bersanelli suggests that cancer patients receiving immunotherapy with ICIs could be more immunocompetent than cancer patients undergoing chemotherapy. However, there are two major risks involved with ICIs, the first being lung toxicity from anti-PD-1/PD-L1 therapy. The second risk is cytokine-release syndrome (CRS), a rare syndrome caused by ICIs characterized by an increased inflammatory response that can cause lung failure and acute respiratory distress syndrome. Similar symptoms are seen in SARS-CoV-2 infection and could worsen COVID-19 pathogenesis.
Although hypothetical, Bersanelli goes on to explain why these risks cannot be ignored but can be managed by careful consideration.
The article then discusses the therapeutic implications of tocilizumab in the treatment of COVID-19. Tocilizumab is used for rheumatoid arthritis but has shown efficacy in reducing ICI-induced inflammatory responses, such as CRS. CRS has been proven to reduce T-cell response in cancer patients. Therefore, Bersanelli highlights that clinicians must be careful with cancer patients receiving tocilizumab as it could reduce the immune response against SARS-CoV-2 infection.
However, although cautiousness should be applied, Bersanelli goes on to explain that various factors increase a cancer patient’s risk of tocilizumab worsening a SARS-CoV-2 infection, including timeline of cancer therapy, individual patient considerations and the efficacy of tocilizumab for COVID-19, which still remains to be proven.
Overall, Bersanelli concludes “clinical decisions about cancer patients deserving immunotherapy in the current context of the COVID-19 pandemic should be characterized by separated reflections, avoiding generalizations and remembering their deeply different immunological status compared with that of cancer patients undergoing chemotherapy or targeted agents.”