Immuno-oncology therapy and COVID-19: What are the potential benefits and risks of undergoing immune checkpoint inhibitor-based therapy for advanced non-small cell lung cancer during a COVID-19 pandemic?

Abstract

Introduction: The COVID-19 pandemic raises several challenges around the treatment of non-small cell lung cancer (NSCLC) using immune checkpoint inhibitor (ICI) based therapy. ICI-therapy, also known as immuno-oncology (IO) therapy, is an upcoming approach to cancer management for several indications, and works by blocking key immune checkpoints, which enables the immune system to destroy tumour cells. Challenges include the potential risk of more severe/frequent immune-related adverse events (irAEs) in COVID-19 patients.Aim: Explore the risks and benefits of IO-therapy for NSCLC during a COVID-19 pandemic and review current guidelines.Case presentation: Patient X is a 70-year-old man with NSCLC who has resumed ICI-therapy after sustaining COVID-19 lung changes following his recent infection.Method: Medical histories were taken from three ICI-patients with NSCLC. In addition, a literature review was undertaken, looking at databases including PubMed, Medline, and Scopus. Key words such as ‘covid-19’, ‘immunotherapy’ and ‘NSCLC’ were used to identify relevant literature and the literature reviewed ranged from 2015 to present day.Results: Several studies identified poor clinical outcomes associated with IO-therapy use in lung cancer patients throughout this pandemic. However, a large body of literature suggests IO-therapy does not influence the survival of patients with COVID-19 nor the likelihood of severe complications. Thus, complete discontinuation of IO may not be necessary, though many studies did suggest that greater COVID-19 surveillance of IO patients be implemented.Significance: Cases such as Patient X, who have COVID-19 lung changes and resume IO, are rarely seen in the literature; therefore, there is minimal guidance for similar situations. This study highlights vital areas for future research including the implications of a COVID-19 vaccine.Conclusion: It is possible for NSCLC patients to undergo IO-therapy during the COVID-19 pandemic. However, the interaction between SARS-CoV-2 and IO-therapy is poorly understood, resultantly it is advised that a case-by-case approach is utilised and patients are involved in the uncertainty of decision-making.