Continued Immunotherapy of Patient with Lung Cancer with
COVID-19
Infection
Jiadi Gan1, Jiaxuan Wu1, Huohuo
Zhang1, Weimin Li#
1 Department of Respiratory and Critical Care Medicine, Institute of
Respiratory Health, Center of Precision Medicine, West China Hospital,
Sichuan University, Chengdu, Sichuan Province, China
Financial/nonfinancial disclosures: None declared.
FUNDING/SUPPORT: This work was supported by the Clinical Research
Incubation Project of West China Hospital of Sichuan University
(2018HXFH012), the National Natural Science Foundation of China
(82200078)
Address for correspondence: Weimin Li, MD, PhD, Department of
Respiratory and Critical Care Medicine, Institute of Respiratory Health,
Center of Precision Medicine, West China Hospital, Sichuan University,
Chengdu, Sichuan Province, China. E-mail:weimi003@scu.edu.cn.
To the Editor :
The COVID-19 pandemic has infected over 763.7 million people globally,
causing over 6.9 million deaths (https://covid19.who.int/; accessed 15
April 2023). Omicron has received much attention for just 2 weeks after
its appearance on November 11th, 2021 for its rapidly
spreaded variants infectivity. The emerging of new variants of
SARS-CoV-2 become the predominant strains during the pandemic. Similar
with comorbidities such as diabetes and cardiovascular
disease1, patients with cancer seems to be highly risk
of acute respiratory syndrome coronavirus 2 (SARS-CoV-2)2.
A major consideration in the delivery of cancer care is to balance the
duration of delaying the cancer-directed therapy. SARS-CoV-2 can
mediated immune system activation by triggerring cytokine
release3, which may lead to a great potential for
treating SARS-CoV-2 infections by targeting immune related receptors. To
mild to moderate COVID-19 or asymptomatic positive SARS-CoV-2 patients,
the NCCN Guidelines recommend considerring holding immune checkpoint
inhibitors therapy for at least 10 days and until improvement of
symptoms (https://www.nccn.org). Whether checkpoint inhibitor treatment
lead to a better or worse outcome maintain controversial. Here, we
report the management of three lung cancer patients during Omicron
period through a multidisciplinary perspective on the basis of clinical
experience and the available data in the literature, the general
characteristic of patients were showed in Table 1 .
The first case is a 65-year-old male, 30 years of smoking history, with
a 1.8cm*1.3cm right lower lobe node, with liver and multiple bone
metastases. Liver lesion puncture biopsy prompt neuroendocrine tumor.
Next generation sequencing (NGS) detection indicated no oncogenic
mutations. The patient had symptoms of fatigue and fever and performed
rapid test of nasopharyngeal swab for respiratory SARS-CoV-2 viruse,
which prompt strongly positive. He commenced with slurryMab combined
with etoposide and carboplatin as first-line therapy. A computed
tomography (CT) scan of the chest revealed lesion reduction after 3
months, with disease assessment of partial response (PR) (Figure
1B ). The second case was a 63-year-old Chinese male ex-smoker presented
with a pulmonary mass in the right lobe lung apex mass discovered on
chest enhanced-CT scan, with bilateral lung and bone metastasis.
Histologic examination of the biopsy samples at lung mass led to the
diagnosis of advanced lung squamous carcinoma. COVID-19 nucleic acid
test prompt positive. He signed informed consent and was treated with
was treated with Pembrolizumab+Vibostolimab. CT scan after 2 month
showed obvious shrinkage in lung mass, contributing to PR
(Figure 1B ). The patient reported feeling better after and no
side effects occurred. The third was a 70-year-old male never-smoker
referred to a local hospital for repetitive cough in June 2022. Chest-CT
scan revealed a pulmonary mass in the left upper lobe and left pleural
thickening. Cerebral magnetic resonance image demonstrated no brain
metastasis and bone imag revealed multiple bone metastases. Biopsy on
lung tissue demonstrated squamous carcinoma and subsequent targeted NGS
detected no oncogenic mutations. Then the patient started duvalizumab
combined with albumin paclitaxel and carboplatin as first-line therapy
for four circles and single-agent duvalizumab maintenance for two
cycles. Nasal swab was positive for COVID-19 in January
12th, 2023. He received nirmatrelvir plus ritonavirand
for strongly positive of COVID-19 nucleic acid test with low Ct value.
The clinical cough symptom of patients improved two days later and he
continued receiving duvalizumab maintenance treatment. Stable lung
lesions were shown through CT scan after 1 months and no novel added
COVID-19 symptoms presented (Figure 1B ). Above patients
manifest no viral symptom after active treatment with checkpoint
inhibitor and continue to receive anti-tumor treatment (Figure
1A ).
The cancer patients receiving antitumour treatments should be strictly
screened for COVID-19 infection during epidemic period and avoid
treatments causing immunosuppression or decrease the dosages of
medication. These cases emphasized immunotherapy has no detrimental
effect on the outcome of mild to moderate patients with COVID-19.