COVID-19 and Patients Receiving Anticancer Immunotherapy

By Ryan M. Weight, DO, MS

Ryan Weight
Ryan Weight, DO, MS
Assistant Professor, Department of Medical Oncology
University of Colorado
Denver, Colorado

Ryan Weight, DO, MS, joined the University of Colorado School of Medicine faculty in 2019 as an assistant professor of medicine with a focus on the treatment of skin malignancies, including melanoma. Prior to this appointment, Dr. Weight served as an assistant professor of medicine at Thomas Jefferson University School of Medicine in Philadelphia.  In 2017, Dr. Weight was appointed leader of the cutaneous malignancy service line within the melanoma division of medical oncology. Dr. Weight established and served as co-director of the Complex Cutaneous Oncology Multidisciplinary Clinic in the Center for Heritable and Connective Tissue Skin Diseases, which brought together dermatology and medical oncology services for the treatment of dysplastic nevus syndrome, patients with a genetic predisposition to skin cancer, erythema bullosum, and others.

Dr. Weight has an interest in the management of immune-related adverse events caused by immune-activating therapies commonly used for the treatment of skin cancers. He served as director of the Immuno-Oncology Clinical Working Group at Thomas Jefferson University (2016- 2018), and as principal investigator for a number of clinical trials focused on the treatment of melanoma, including early phase trials. He has co-authored a multi-center adjuvant study of Nivolumab for the treatment of resected high-risk melanoma patients. 

  November 20, 2020

SARS-CoV-2 and the resulting respiratory tract infection COVID-19 has upended our society and forcefully changed the way we care for patients. Since the emergence of the virus in early 2020, there have been questions surrounding the risk posed to patients with a cancer diagnosis and the safety of anticancer therapies. The desired effect of immune checkpoint blockade (ICB) drugs is to activate the innate immune system (t-cell subset) to recognize cancer cells as foreign and harness the immune system to eradicate disease. But can this heightened state of immune awareness result in a protective effect against pathogens like viruses and bacteria? Or is the potential inflammation generated from immune activation detrimental to those exposed to infectious pathogens1?

Three large, retrospective cohort studies regarding the clinical impact of COVID-19 on patients with cancer have been published2,3,4. The largest report up until September 30, 2020, comes from the COVID-19 and Cancer Consortium (CCC19), which reported 30-day all-cause mortality for 928 patients from the United States, Canada, and Spain with laboratory confirmed SARS-CoV-2 and a diagnosis of invasive or hematologic malignancy between March 17, and April 16, 2020. Of those receiving anticancer therapy, only 16% (38 patients) had received immunotherapy, including ICB, allogeneic stem cell transplant, or adoptive cell therapy. The authors did not report the mortality risk for those patients receiving immunotherapy, however, type of malignancy, type and recency of anticancer therapy, and surgery were not associated with an increase in all-cause mortality2.
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References

  1. Failing et. al. Safety of influenza vaccine in patients with cancer receiving pembrolizumab. JCO Oncology Practice. 2020 July; 16(7):e573-e580.
  2. Kuderer et. al. Clinical impact of COVID-19 on patients with cancer (CCC19) a cohort study. Lancet Oncology. 2020 May; 395:1907-18.
  3. Whisenant et. al. TERAVOLT: Thoracic Cancers International COVID-19 Collaboration. Lancet Oncology. 2020 July; 21(7):914-922.
  4. Jee et. al. Chemotherapy and COVID-19 outcomes in patients with cancer. JCO. 2020 Aug; 38:1-9.