In early reports from China,3 5.6% of patients with cancer and COVID-19 died, higher than the 3% overall mortality rate from that report, and similar to the case fatality rate of people with diabetes (7.3%) and chronic respiratory disease (6.3%).
“It’s a high rate and very concerning and alarming. Our patients are vulnerable and immunocompromised — we are recommending quarantine for 14 days for asymptomatic COVID-19 patients with lung cancer and hospitalization for those who are symptomatic,” said Dr Salgia.
Despite the high heterogeneity of the patient population and very small numbers of patients, the fact that no relationship between previous PD-1 blockade and COVID-19 severity was initially found should be at least mildly reassuring to patients on PD-1 inhibitors and the physicians treating them.
“Although this study was small and preliminary, the findings did not indicate that these therapies should not be administered during this pandemic. But larger studies are needed to investigate this thoroughly before firm conclusions can be made,” said Dr Awad.
The study does, however, raise severe concerns about the high rate of mortality in lung cancer patients — irrespective of immune checkpoint blockade — and raises many more questions about the future use of these therapies, assuming the COVID-19 pandemic may be a consideration in cancer therapy decisions for some time.
“A key question is, should immune checkpoint blockade be given to patients who had previous COVID-19? Should you check patients for COVID-19 before giving these therapies, or see if a patient has antibodies against SARS-CoV-2 and then, see how they fare? We have to be uniform with our thinking about our guidelines or you could miss out on a chance for a successful treatment, or even cause catastrophe,” said Dr Salgia.
Immune checkpoint blockade are not the only therapies being investigated in the context of how they might impact the outcomes of patients with cancer and COVID-19/ Several ongoing investigations are trying to figure out if and how various cancer therapies might influence the risk of severe or fatal COVID-19.
“You have to also consider not just immune checkpoint blockade; a lot of patients also get targeted therapies, which can cause problems in the lungs; even radiation therapies and tyrosine kinase inhibitors. We have to be cognizant of this in the COVID-19 era. We need more data and thankfully, more [are] coming,” said Dr Salgia.
- Luo J, Rizvi H, Egger J, et al. Impact of PD-1 blockade on severity of COVID-19 in patients with lung cancers. Cancer Discov. doi: 10.1158/2159-8290.CD-20-0596
- Dai M, Liu D, Liu M., et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak [published online April 28, 2020]. Cancer Discov. doi: 10.1158/2159-8290.CD-20-0422
- The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team; Feng Z, Li Q, Zhang Y, et al. Vital surveillances: The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) — China, 2020. Chinese Center for Disease Control and Prevention (China CDC) Weekly. 2020;2(8):113-122.