COVID-19 Pandemic Poses Challenges for Lung Cancer Therapy

By Will Boggs MD

April 20, 2020

NEW YORK (Reuters Health) - The COVID-19 pandemic presents a number of challenges for patients with lung cancer, according to a commentary.

"Extra caution should be taken in this COVID time for the potential overlaps between side effects of immunotherapy and of COVID infection," Dr. Michele Maio from University Hospital of Siena, Italy told Reuters Health by email. "A strong recommendation is to activate molecular screening for COVID infection for all new patients at the beginning of therapy and then whenever symptoms may be suggestive of a COVID superinfection."

The inevitable reallocation of healthcare resources toward patients with COVID-19 has raised concern within the medical oncology community, and in some areas physicians are increasingly forced to select which patients should receive anticancer therapy on the basis of who is most likely to respond.

Dr. Maio and colleagues describe the high risk of interference of COVID-19 with the effective diagnostic and therapeutic management of patients with lung cancer in their online commentary in Lancet Respiratory Medicine.

The clinical manifestations of COVID-19-induced pneumonia are similar to those of immune checkpoint inhibitor- and tyrosine kinase-induced pneumonitis, and the main CT findings can overlap those found in patients with lung cancer upon disease progression or the onset of concomitant pneumonia resulting from overlapping opportunistic infections.

Distinguishing between these possibilities is challenging, and these specific conditions require very different therapeutic approaches.

In these scenarios, standard chemotherapy does not seem to be a suitable or potentially safer alternative to immune checkpoint inhibitor therapy, partly because of its lesser efficacy and partly because chemotherapy-associated pneumonitis can also develop in up to 16% of patients. Moreover, chemotherapy within the month preceding a COVID-19 diagnosis has been associated with a higher risk of severe infection-related complications.

While awaiting specific evidence-based guidelines, the authors suggest, it seems reasonable that patients with lung cancer undergo systematic testing for SARS-CoV-2, the virus that causes COVID-19, at the beginning of treatment and whenever it is deemed necessary by the treating physician.

Even more than usual, management of these patients should involve specific and careful attention to their radiological pulmonary signs.

Physicians "should not worry about using immunotherapy in their lung cancer patients when, as it is in most cases, it represents the best therapeutic option," Dr. Maio said.

He added, "A strong suggestion would be to collect as much data as possible prospectively on the COVID status at the beginning and during therapy in lung cancer patients treated with immune checkpoint therapy to understand the possible reciprocal interference of the two."

SOURCE: Lancet Respiratory Medicine, online April 9, 2020.