Chemotherapy/immunotherapy
A study of 1590 patients diagnosed with COVID-19 in China, showed that
about 1% of these patients had concurrent diagnosis of cancer, and
these patients were at higher risk for significant complications from
viral infection (ICU admission, ventilator dependence or
death).30 Chemotherapy agents can lead to
immunosuppression and deconditioning that may leave patients more
susceptible to COVID-19 infection. Furthermore, those undergoing active
treatment, with recent surgery or cytotoxic chemotherapy, were at
highest risk of complications.30 Consideration should
be given for the use of less myelosuppressive agents and for the use of
granulocyte colony-stimulating factors to avoid infectious
complications.
The potential interaction between COVID-19 infection and treatment with
immune checkpoint inhibitors (ICI) is not known.30,31There may be potential benefits derived from boosting the immune system
for protection from infection. However, there is also potential for
pulmonary complications. While immune related adverse events in
checkpoint inhibitors are very low, pneumonitis represents the most
severe potential complication responsible for a majority of deaths
(79%).32 Therefore, concurrent ICI-related
pneumonitis with ARDS lung damage from COVID-19 could cause significant
morbidity. In addition, some morbidity of severe COVID-19 infection has
been attributed to immune hyperactivation and cytokine
storm,33 which could be worsened by immune checkpoint
inhibition. No reports have been published on outcomes of ICI therapy
with concurrent COVID-19 infection 31, but potential
risks should be considered and discussed with patients.