Abstract
After the COVID-19 outbreak, non-evidence based guidelines were published to advise clinicians on the adjustment of oncological treatment during this pandemic. As immune checkpoint inhibitors directly affect the immune system, concerns have arisen about the safety of immunotherapy during this pandemic. However, data on the immune response in oncology patients treated with immunotherapy are still lacking. Here, we present the adaptive immune response in a SARS-CoV-2 infected patient who was treated with immune checkpoint inhibitors for advanced renal cell cancer. To evaluate the immune response in this patient, the number of T cells and their major subsets were measured according to expression of markers for co-signalling, maturation, and chemotaxis at baseline, during therapy, and during the SARS-CoV-2 infection. In addition, plasma samples were analyzed for IgM and IgG antibodies and the ability of these antibodies to neutralise SARS-CoV-2. Despite several risk factors for an impaired immune response to SARS-CoV-2, both T- and B-cell responses were observed. Moreover, after treatment with immune checkpoint inhibitors, a sufficient cellular and humoral immune response was achieved in this SARS-CoV-2 infected patient. These findings warrant renewed discussion on withholding of immune checkpoint inhibitors during an ongoing COVID-19 pandemic.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is having significant impact on oncological care
We present for the first time data of the T and B cell responses in a SARS-CoV-2 infected patient who was treated with nivolumab and ipilimumab for advanced renal cell cancer (RCC)
In this patient, who was infected with SARS-CoV-2 and treated with immune checkpoint inhibitors (ICIs) for metastatic RCC, an adequate cellular and humoral immune response was measured, despite the presence of risk factors for an impaired immune response and a severe course of SARS-CoV-2
Summary
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is having significant impact on oncological care. We present for the first time data of the T and B cell responses in a SARS-CoV-2 infected patient who was treated with nivolumab and ipilimumab for advanced renal cell cancer (RCC). At the time of hospital admission (2 days after the onset of symptoms), the patient had been treated with prednisolone (1mg/kg daily) for four weeks and the last dose of nivolumab had been administered six weeks earlier. The counts of total leukocytes showed a strong decrease from 6,9x103/μl at T1 to 3.9 x103/μl at T2, which was predominantly caused by a decrease in lymphocyte counts (Supplementary Table 1) [14, 15] For both CD4 + and CD8+ T cells the fractions of central (CD45RA-, CCR7+) and effector (CD45RA-, CCR7-) memory T cells decreased, whereas those of naïve T cells (CD45RA+, CCR7+) increased when comparing T2 versus T1 and baseline (Figure 1).
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