No abstract

Since we are not able to consider ICIs treatment as highly immunosuppressive, avoiding it in cancer patients to reduce coronavirus infections could deprive these patients from a highly active class of drugs. "The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has been declared a pandemic by the WHO that claimed the lives of thousands of people within a few months. Cancer patients represent a vulnerable population due to the acquired immunodeficiency associated with anti-cancer therapy. Immune checkpoint inhibitors have largely impacted the prognosis of a multitude of malignancies with significant improvement in survival outcomes and a different, tolerable toxicity profile. In this paper, we assess the safety of ICI administration in cancer patients during the coronavirus pandemic in order to guide the usage of these highly efficacious agents.

with a cluster of pneumonia cases in Wuhan, a city within the central part of China, and has rapidly evolved into a global pandemic [1]. The putative pathogen is a novel coronavirus that presents a close resemblance to a known bat coronavirus termed BatCoV RaTG13, thus favoring a bat-to-human transmission hypothesis before eventually identifying human-to-human transmission [2,3]. It presents a high transmission rate with one new infected case producing an average of 2.9 new secondary cases and a fatality rate of 2.3% [4,5]. As a result, thousands of severe cases have died every day worldwide due to the pressure on the healthcare system and lack of specific treatments. Not surprisingly, cancer patients, compared with the general population, are regarded as a highly vulnerable group because of their immunosuppressive state due to malignancy, chemotherapy and comorbidities. Thus, oncologists are obliged to reconsider anticancer treatments while taking into consideration the risk of complication and cancer progression [6]. An updated WHO report demonstrates a mortality of 7.6% among patients with cancer [7]. Subsequently, several societies have issued conservative guidelines inviting oncologists to consider, on a case-by-case basis, the possibility of delaying treatment administration [8][9][10][11][12]. In this paper, we provide the oncologists with the available evidence concerning COVID-19 in cancer patients to better guide management decisions. COVID-19 infections in cancer patientsAs China was the first epicenter for the pandemic, the Chinese epidemiological data constitutes the bulk of published literature reporting COVID-19 infections. The early case series including a total of 300 COVID-19 patients identified 2 cancer patients only [4,13]. Later case series by Liang et al. (18 cases), Zhang et al. (28 cases) and Zhang et al. (67 cases) reported a higher prevalence of cancer patients with COVID-19 infections compared with the overall population (1 vs 0.29%) [14], a higher median age at diagnosis (63-66 vs 49 years) [14][15][16] and a male predominance (61%) [15,16]. Lung cancers (22-25%), gastrointestinal cancers (14-16%) and breast cancers (11%) were the most commonly encountered tumors [15,16]. The clinical features included fever (80-82%), dry cough (75-81%) and dyspnea (50-66%) [15,16]. Dyspnea was more frequently noted at admission in severe cases (56.3 vs 11.4%) and in nonsurvivors (66.7 vs 20.4%) whereas the other symptoms were similar between mild and severe cases [16]. Laboratory tests showed hypoproteinemia (89%), lymphopenia (82%), increased level of CRP (82%) and anemia (75%) [15]. In comparison with patients without cancer, cancer patients had a higher risk of adverse events (39 vs 8%; p = 0.0003) and deteriorated more rapidly (13 vs 43 days, HR = 3.56; 95% CI: 1.65-7.69) [14]. Severe events were reported in 48-54% of cases (versus 16% in the overall population), notably among patients receiving anticancer treatment within the previous 2 weeks (OR = 4.079; 95% CI: 1.086-15.322) [14][15][16]. Compa...