Abstract
COVID-19 has become the biggest public health problem and one of the most important causes of death in many countries in the world. SARS-CoV-2 infection is most likely to be fatal in elderly patients with concomitant diseases. In this article we present two cases of asymptomatic SARS-CoV-2-positive patients suffering from cancer who were treated with chemotherapy. The first case, a patient with primary mediastinal B-cell lymphoma, shows that confirmed SARS-CoV-2 infection does not have to be a contraindication to chemotherapy. We describe the course of disease and discuss doubts related to the choice of chemotherapy regimen. The second patient was a male with metastatic sigmoid cancer treated with FOLFOX4 as first-line palliative chemotherapy. This case draws attention to asymptomatic SARS-CoV-2 carriers who underwent chemotherapy. Our patient was safely treated with chemotherapy without long break caused by viral infection. It should be remembered that there are asymptomatic carriers among cancer patients and that they may spread infection to others. On the other hand, delaying chemotherapy can cause rapid disease progression and reduce overall survival of our patients.
Highlights
Coronavirus disease 2019 (COVID-19) is a disease known since December 2019, caused by SARSCoV-2 virus
It has been proven that small doses of dexamethasone reduce mortality in severe COVID-19 by stopping autoimmune destruction of the lungs [23]
It has been proven in an open randomized trial that dexamethasone reduces 28-day mortality in patients hospitalized due to SARSCoV-2 [25]
Summary
Coronavirus disease 2019 (COVID-19) is a disease known since December 2019, caused by SARSCoV-2 virus. The patient was complaining of mild constant chest discomfort, but this symptom was present before SARS-CoV-2 infection and most probably caused by the presence of tumor mass in the mediastinum. It was decided to treat patient with chemotherapy according to CHOP-14 regimen (cyclophosphamide 750mg/ m2, doxorubicin 50mg/m2, vincristin 1,4mg/m2, prednisone 40mg/m2) It was decided against the use of rituximab due to the risk of negative effect on SARS-CoV-2 infection. The patient was in good performing status (ECOG 1), complaining of polyneuropathy grade 1 after oxaliplatin treatment He had coronary heart disease; he underwent myocardial infarction in. This investigation revealed positive antibody levels: IgM 4.54 s/c (>0.99 considered positive) and IgG 4.16 (>1.40 considered positive) This shows that our patient had asymptomatic SARS-CoV-2 infection during chemotherapy. The patient is still continuing chemotherapy without any new side effects and complications
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