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. 2020 Sep;50(9):e13315.
doi: 10.1111/eci.13315. Epub 2020 Jul 5.

Italian survey on managing immune checkpoint inhibitors in oncology during COVID-19 outbreak

Marco Tagliamento  1   2 , Francesco Spagnolo  2 , Francesca Poggio  2 , Davide Soldato  1   3 , Benedetta Conte  1   2 , Tommaso Ruelle  2 , Emanuela Barisione  4 , Andrea De Maria  5   6 , Lucia Del Mastro  1   7 , Massimo Di Maio  8 , Matteo Lambertini  1   3
Affiliations

Italian survey on managing immune checkpoint inhibitors in oncology during COVID-19 outbreak

Marco Tagliamento et al. Eur J Clin Invest. 2020 Sep.

Abstract

Background: During COVID-19 outbreak, oncological care has been reorganized. Patients with cancer have been reported to experience a more severe COVID-19 syndrome; moreover, there are concerns of a potential interference between immune checkpoint inhibitors (ICIs) and SARS-CoV-2 pathogenesis.

Materials and methods: Between 6 and 16 May 2020, a 22-item survey was sent to Italian physicians involved in administering ICIs. It aimed at exploring the perception about SARS-CoV-2-related risks in cancer patients receiving ICIs, and the attitudes towards their management.

Results: The 104 respondents had a median age of 35.5 years, 58.7% were females and 71.2% worked in Northern Italy. 47.1% of respondents argued a synergism between ICIs and SARS-CoV-2 pathogenesis leading to worse outcomes, but 97.1% would not deny an ICI only for the risk of infection. During COVID-19 outbreak, to reduce hospital visits, 55.8% and 30.8% opted for the highest labelled dose of each ICI and/or, among different ICIs for the same indication, for the one with the longer interval between cycles, respectively. 53.8% of respondents suggested testing for SARS-CoV-2 every cancer patient candidate to ICIs. 71.2% declared to manage patients with onset of dyspnoea and cough as infected by SARS-CoV-2 until otherwise proven; however, 96.2% did not reduce the use of steroids to manage immune-related toxicities. The administration of ICIs in specific situations for different cancer types has not been drastically conditioned.

Conclusions: These results highlight the uncertainties around the perception of a potential interference between ICIs and COVID-19, supporting the need of focused studies on this topic.

Keywords: COVID-19; SARS-CoV-2; cancer; immune checkpoint inhibitors; immunotherapy.

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Conflict of interest statement

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Tagliamento reported travel grants from Roche, Bristol‐Myers Squibb, AstraZeneca, Takeda and Honoraria as medical writer from Novartis outside the submitted work. Dr Poggio declares travel, accommodations, expenses supported by Takeda, Ely Lilly, and received honoraria from Merck Sharp & Dohme, Ely Lilly, Novartis outside the submitted work. Dr Del Mastro declares personal fees from Roche, Pfeizer, Ipsen, Eli Lilly, Novartis, Takeda, Merck Sharp & Dohme, Genomic Health and Seattle Genetics, and non‐financial support from Celgene, outside the submitted work. Dr Di Maio acted as consultant for Eisai, Takeda, Janssen, Astellas, Pfizer and AstraZeneca, outside the submitted work. Dr Lambertini acted as a consultant for Roche and Novartis, and received honoraria from Theramex, Roche, Lilly, Pfizer and Novartisoutside the submitted work. Dr Spagnolo, Dr Soldato, Dr Conte, Dr Ruelle, Dr Barisione and Dr De Maria declare no competing interests.

Figures

Figure 1
Figure 1
A, Perception regarding a possible interference between the activity of immune checkpoint inhibitors and the pathogenesis of SARS‐CoV‐2 infection. B, Perception regarding the potential increased risk of severe events related to SARS‐CoV‐2 infection in cancer patients treated with immune checkpoint inhibitors
Figure 2
Figure 2
Attitude towards the type of immune checkpoint inhibitor chosen and the treatment's schedule. (Abbreviation: ICI, immune checkpoint inhibitor)
Figure 3
Figure 3
Indication to test for SARS‐CoV‐2 every cancer patient candidate to receive an immune checkpoint inhibitor
Figure 4
Figure 4
A, Management of dyspnoea and cough in cancer patients treated with immune checkpoint inhibitors during COVID‐19 outbreak. B, Management of colitis in cancer patients treated with immune checkpoint inhibitors during COVID‐19 outbreak
Figure 5
Figure 5
Use of immune checkpoint inhibitors in the adjuvant setting for patients with stage III melanoma older than 75 years
See this image and copyright information in PMC

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