Case Report: Adequate T and B Cell Responses in a SARS-CoV-2 Infected Patient After Immune Checkpoint Inhibition

Abstract

After the COVID-19 outbreak, non-evidence based guidelines were published to advise clinicians on the adjustment of oncological treatment during this pandemic. As immune checkpoint inhibitors directly affect the immune system, concerns have arisen about the safety of immunotherapy during this pandemic. However, data on the immune response in oncology patients treated with immunotherapy are still lacking. Here, we present the adaptive immune response in a SARS-CoV-2 infected patient who was treated with immune checkpoint inhibitors for advanced renal cell cancer. To evaluate the immune response in this patient, the number of T cells and their major subsets were measured according to expression of markers for co-signalling, maturation, and chemotaxis at baseline, during therapy, and during the SARS-CoV-2 infection. In addition, plasma samples were analyzed for IgM and IgG antibodies and the ability of these antibodies to neutralise SARS-CoV-2. Despite several risk factors for an impaired immune response to SARS-CoV-2, both T- and B-cell responses were observed. Moreover, after treatment with immune checkpoint inhibitors, a sufficient cellular and humoral immune response was achieved in this SARS-CoV-2 infected patient. These findings warrant renewed discussion on withholding of immune checkpoint inhibitors during an ongoing COVID-19 pandemic.

COVID-19 and the pituitary

“…Indeed, the potential impact of ICIs as well as of other monoclonal antibodies used in endocrine patients such as denosumab [94]on the clinical outcome of COVID-19 has not been yet fully evaluated. However, a very recent case report demonstrated a sufficient cellular and humoral immune response in a SARS-CoV-2 infected patient who was on treatment with immune checkpoint inhibitors for advanced renal cell cancer, supporting the concept of not suspending ICIs during the ongoing COVID-19 pandemic [95].…”

Extracellular vesicles derived from SARS-CoV-2 M-protein-induced triple negative breast cancer cells promoted the ability of tissue stem cells supporting cancer progression

“…Numerous studies have suggested that COVID19 increases the risk of accelerated cancer progression, metastasis, and death in cancer patients in general and in breast cancer patients in particular ( 5 , 12 , 13 , 54 , 55 ). Indeed, our previous study reported the induced effects of the SARS-CoV-2 M-protein on the migratory ability and metastasis of BCC, suggesting that it promoted aggressiveness in BCC ( 6 ).…”

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

“… NA CRP↑ Paracetamol Improved and continue with the adjuvant treatment while delaying the next dose by 3 weeks 4 Arenbergerova et al [ 35 ] 59/M Czech NA Melanoma, stage IIIB Pembrolizumab, Q3W NA Fever, fatigue, dry cough. NA CRP↑ Paracetamol Improved and continue with the adjuvant treatment while delaying the next dose by 3 weeks 5 Artigas et al [ 36 ] 51/M Belgium NA Renal cell carcinoma Nivolumab NA Fatigue, anorexia Ground glass opacities in both lungs LDH: 365 U/L; lymphocyte: 1.16*10 3 /mm 3 ; CRP: 167 mg/L Hydroxychloroquine, piperacillin/tazobactam NA 6 de Joode et al [ 37 ] 62/M Netherlands Type 2 diabetes, hypertension Renal cell cancer with metastases Ipilimumab, nivolumab 42 Cough, dyspnea NA Lymphocytes↓ Prednisolone, cefuroxime, azithromycin Died 30 days after discharged due to severe neurological deterioration 7 Di Giacomo et al [ 38 ] 74/M Italy Renal cell carcinoma Metastatic cutaneous melanoma Anti-PD-1, 83 cycles 5 Fever, mild dyspnea, cough Bilateral pneumonitis CRP: 4.22 mg/liter; lymphocytes: 1060/mm 3 Azithromycin, darunavir/ritonavir, hydroxychloroquine, oxygen therapy Improved and resumed ICI treatment 8 Di Giacomo et al [ 38 ] 51/F Italy NA Melanoma, stage IV Anti-PD-1, 11 cycles 6 Asthenia, nausea, fever, headache NA CRP: 1.1 mg/liter; lymphocytes: 1105/mm 3 Self-isolation ...…”