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.