Don’t Delay Lung Cancer Immunotherapy Treatment Over Fear of COVID-19

In severe cases, COVID-19 can rev up the immune system to a dangerous degree. The immune system overreacts to the virus, causing massive inflammation and attacking not just the virus but healthy cells, too. It's this immune response that can lead to lung failure and make people unable to breathe on their own.

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People with cancer who take checkpoint inhibitors know the risks of an outsized immune reaction all too well. Checkpoint inhibitors, an immunotherapy drug for lung and certain other cancers, rev up the immune system, too. They come with the risk of a rare side effect called pneumonitis, a potentially life-threatening lung inflammation.

New research suggests that the life-saving benefits of checkpoint inhibitors in people with advanced lung cancer outweigh the potential for risks.

Given that COVID-19 is a lung infection, this all led researchers to ask whether the COVID-19 in people getting immunotherapy for lung cancer could be a recipe for serious complications. New research suggests that the life-saving benefits of checkpoint inhibitors in people with advanced lung cancer outweigh the potential for risks.

What the Research Tells Us

Several recent studies have examined what it means for people receiving checkpoint inhibitors for lung cancer if they get infected with the coronavirus. The consensus seems to be that other underlying health conditions, not the type of cancer treatment, raise risk for severe COVID-19.

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Here's a rundown of several studies that find no increased risk from checkpoint inhibitors:

• In a study of 113 people with COVID-19 who were receiving checkpoint inhibitors for different cancers, including lung cancer, the death rate was similar to that of the general cancer population.
• In a study of 200 patients who had COVID-19 and any thoracic cancer (including lung cancer), checkpoint inhibitors didn't worsen COVID-19 cases.
• In a study of 102 patients who had COVID-19 and lung cancer, specifics of the cancer or treatment did not raise the risk for more severe illness. Underlying lifestyle and health conditions, such as smoking, COPD, and high blood pressure, did.

It's important to note, says Patel, that people who receive immunotherapy for lung cancer may be sicker to begin with. "Cancer immunotherapy is typically used in lung cancer patients who are smokers. They may also have COPD," says Patel, who led the writing of lung cancer and COVID-19 guidelines for the National Comprehensive Cancer Network. "These are patients who are high risk to begin with, who are fighting a high-risk lethal disease."

Another study of 423 people, however, did find an increased risk of severe COVID-19 in people getting checkpoint inhibitors. That was both in people with lung cancer and with other cancers. But, there's a caveat. Only one of the 31 patients receiving checkpoint inhibitors received the standard steroid treatment for calming an overactive immune system before becoming extremely ill.

Patel stresses that steroids are an effective treatment for the extreme immune response that can be a side effect of checkpoint inhibitors and a complication of COVID-19. "Whether it's immune pneumonitis one of the side effects of immunotherapy independent of COVID-19 – or it's a COVID-related immune response, our treatment for both of these really dangerous diseases is steroids," Patel says. "You've got to make the diagnosis and treat aggressively."

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The researchers said that their findings did not imply that doctors should change treatment plans for patients receiving immunotherapy. They should just keep a closer watch on these patients and monitor for COVID-19.

Continue Your Treatment

Above all, Patel stresses, people with lung cancer who are taking checkpoint inhibitors need to continue their treatment.

"We are dealing with an aggressive, lethal disease with drugs that are very effective. These patients can now live years and years because of these drugs."

What Do Checkpoint Inhibitors Do For Cancer? 

Doctors don't know which patients with have an extreme immune reaction whether in response to checkpoint inhibitors or as a complication of COVID-19. "But we do know that if patients don't get immunotherapy, their cancer could get out of control," he says.

Avoid COVID-19

Rather than concern about immunotherapy, Patel says, what you should take from the research is added motivation to prevent COVID-19.

"The way I read the data is be particularly focused on prevention for these patients because they are so high risk to begin with, but don't change what you would otherwise do for patients with high-risk lethal disease because these therapies are so effective."

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