A Single Center Retrospective Study of the Impact of COVID-19 Infection on Immune-related Adverse Events in Cancer Patients Receiving Immune Checkpoint Inhibitors

Guo, Mengni; Liu, Jieying; Miao, Ruoyu; Ahmed, Zohaib; Yu, James; Guan, Jian; Ahmad, Sarfraz; Zhou, Shuntai; Grove, Angela; Manoucheri, Manoucher; Socinski, Mark A.; Mekhail, Tarek

doi:10.1097/cji.0000000000000440

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…Histological findings of EMB shows infiltration of CD4- and CD8-positive lymphocytes in myocardial tissue, as well as CD68-positive macrophages in patients with severe clinical symptoms, such as fulminant myocarditis ( 20 , 21 ). There are reports that the SARS-CoV-2 genome was detected in myocardial tissue from some COVID-19 patients ( 22 – 25 ). However, there have been reports of virus-negative COVID-19-associated myocarditis, and the authenticity of the SARS-CoV-2 genome remains uncertain ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis

et al. 2023

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Immune checkpoint inhibitor (ICI)-induced myocarditis is rare but fatal. Because of the rapid course of ICI-induced myocarditis, understanding of clinical course is only possible through information from case reports. We report a case of pembrolizumab-induced myocarditis in which we were able to document the course of electrocardiographic changes from onset to death. A 58-year-old woman with stage IV lung adenocarcinoma, who had completed her first cycle of pembrolizumab, carboplatin, and pemetrexed, was admitted with pericardial effusion. She underwent pericardiocentesis after admission. A second cycle of chemotherapy was administered 3 weeks after the first cycle. Twenty-two days after admission, she developed a mild sore throat and tested positive for SARS-CoV-2 antigen. She was diagnosed with mild coronavirus disease 2019 (COVID-19), isolated, and treated with sotrovimab. Thirty-two days after admission, an electrocardiogram showed monomorphic ventricular tachycardia (VT). Suspecting myocarditis caused by pembrolizumab, the patient was started on daily methylprednisolone after coronary angiography and endocardial biopsy. Eight days after the start of methylprednisolone administration, she was considered to have passed the acute stage. However, four days later, R-on-T phenomenon triggered polymorphic VT and she died. The impact of viral infections such as COVID-19 on patients be treated with immune checkpoint inhibitors is still unknown and we need to be careful with systemic management after viral infections.

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Section: Discussionmentioning

confidence: 99%

Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis

et al. 2023

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“…Interestingly, previous studies have yielded conflicting results. For example, Mengni Guo et al reported that COVID-19 infection may pose a risk of severe irAEs in cancer patients receiving ICIs [ 24 ]. On the other hand, a registry for thoracic cancers did not find a significant impact of ICIs on COVID-19 outcomes [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies suggest that COVID-19 vaccines are safe for cancer patients receiving anti-PD-1 treatment and that ICIs do not worsen outcomes in cancer patients with COVID-19 [ 18 – 22 ]. Some studies have evaluated the safety and efficacy of ICIs in lung cancer patients with COVID-19 infection [ 23 , 24 ]. The Omicron variant has presented a new challenge to Chinese healthcare systems and care of cancer patients due to its persistent spread in the end of 2022.…”

Section: Introductionmentioning

confidence: 99%

Association of immune-related adverse events with COVID-19 pneumonia in lung cancer patients receiving immune checkpoint inhibitors: a cross-sectional study in China

Che,

Hong,

et al. 2023

BMC Cancer

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Background Immune checkpoint inhibitors (ICIs) are commonly used to treat lung cancer patients, but their use can lead to immune-related adverse events (irAEs), which pose a challenge for treatment strategies. The impact of irAEs on the incidence of COVID-19 pneumonia in lung cancer patients during the ongoing COVID-19 pandemic is unclear. This study aims to investigate the association between irAEs and COVID-19 pneumonia in lung cancer patients receiving ICIs. Methods We conducted a cross-sectional study of lung cancer patients who received ICIs and were infected with COVID-19 due to the Omicron variant between December 2022 and February 2023 in China. We collected data on irAEs and COVID-19 outcomes. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between irAEs and the incidence of COVID-19 pneumonia. Results A total of 193 patients were enrolled, with 72 patients (37.30%) in the irAEs group and 121 patients (62.70%) in the non-irAEs group. Twenty-six patients (13.47%) developed COVID-19 pneumonia and 6 patients (3.11%) progressed to severe cases after COVID-19 infection. Multivariate logistic regression showed that the lung cancer patients who experienced irAEs was significantly associated with a higher incidence rate of COVID-19 pneumonia (OR = 9.56, 95%CI: 2.21–41.33; P = 0.0025). Conclusion Our study suggests that lung cancer patients receiving ICIs and experiencing irAEs may have a higher risk of developing COVID-19 pneumonia due to the Omicron variant. Therefore, close monitoring of these patients during the COVID-19 pandemic is necessary to mitigate this risk.

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“…In addition, ICI immune-mediated lung injury and COVID-19 have overlapping features and common clinical and radiological manifestations, making it not only difficult to distinguish between the two but also impossible to exclude a negative synergistic effect of both on lung injury [ 77 ]. Taken together, clinicians need to be more cautious with ICI-treated cancer patients during COVID-19.…”

Section: Interaction Between Icis and Sars-cov-2 Infectionmentioning

confidence: 99%

SARS-CoV-2 infection and COVID-19 vaccination in cancer patients undergoing immune checkpoint inhibitors

Yang

2023

Cell Death Dis

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Cancer patients are susceptible to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Different antitumor treatments have attracted wide attention in the context of coronavirus disease 2019 (COVID-19), especially immune checkpoint inhibitors (ICIs) that have revolutionized oncology changes. It may also have protective and therapeutic roles in viral infections. In this article, we collected 26 cases of SARS-CoV-2 infection during ICIs therapy and 13 related to COVID-19 vaccination from Pubmed, EMBASE, and Wed of Science. Of these 26 cases, 19 (73.1%) presented mild cases and 7 (26.9%) were severe cases. Melanoma (47.4%) was a common cancer type in mild cases and lung cancer (71.4%) in severe cases (P = 0.016). The results showed that their clinical outcomes varied widely. Although there are similarities between the immune checkpoint pathway and COVID-19 immunogenicity, ICIs therapy overactivated T cells, which often leads to immune-related adverse events. In fact, the COVID-19 vaccine has been shown to be safe and effective in patients treated with ICIs. In this review, we report the vital clinical observations of SARS-CoV-2 infection or vaccination in cancer patients treated with ICIs and explore the potential interaction between them.

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A Single Center Retrospective Study of the Impact of COVID-19 Infection on Immune-related Adverse Events in Cancer Patients Receiving Immune Checkpoint Inhibitors

Cited by 8 publications

References 23 publications

Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis

Case report: Electrocardiographic changes in pembrolizumab-induced fatal myocarditis

Association of immune-related adverse events with COVID-19 pneumonia in lung cancer patients receiving immune checkpoint inhibitors: a cross-sectional study in China

SARS-CoV-2 infection and COVID-19 vaccination in cancer patients undergoing immune checkpoint inhibitors

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