COVID-19 and Cancer Comorbidity: Therapeutic Opportunities and Challenges

Abstract

The coronavirus disease 2019 (COVID-19) is a viral disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that affects the respiratory system of infected individuals. COVID-19 spreads between humans through respiratory droplets produced when an infected person coughs or sneezes. The COVID-19 outbreak originated in Wuhan, China at the end of 2019. As of 29 Sept 2020, over 235 countries, areas or territories across the globe reported a total of 33,441,919 confirmed cases, and 1,003,497 confirmed deaths due to COVID-19. Individuals of all ages are at risk for infection, but in most cases disease severity is associated with age and pre-existing diseases that compromise immunity, like cancer. Numerous reports suggest that people with cancer can be at higher risk of severe illness and related deaths from COVID-19. Therefore, managing cancer care under this pandemic is challenging and requires a collaborative multidisciplinary approach for optimal care of cancer patients in hospital settings. In this comprehensive review, we discuss the impact of the COVID-19 pandemic on cancer patients, their care, and treatment. Further, this review covers the SARS-CoV-2 pandemic, genome characterization, COVID-19 pathophysiology, and associated signaling pathways in cancer, and the choice of anticancer agents as repurposed drugs for treating COVID-19.

Keywords: COVID-19; SARS-CoV-2; cancer; comorbidity; coronaviruses; inflammation.

Figure 1

The confirmed COVID-19 cases and deaths around the world as of 30 September 2020. The number of confirmed COVID-19 cases and deaths per month (a, b), and countries (c, d), around the globe, are presented , .

Figure 2

SARS-CoV-2 structure (a) and genome organization (b). The SARS-CoV-2 genome is comprised of: the 5'-untranslated region (5'-UTR); open reading frame (orf) 1a/b that encodes non-structural proteins (nsp) replicases; structural proteins including spike (S), envelop (E), membrane (M), and nucleoproteins (N); accessory proteins such as orf 3, 6, 7a, 7b, 8, 9b, 11, and 13; followed by 3'-untranslated regions (3'-UTR). Spike (S) protein has two functional domains, S1 (for attachment) and S2 (for fusion) and a polybasic cleavage site at the S1/S2 junction. Molecular characterizations of the S1/S2 cleavage site of SARS-CoV-2 and its closest relatives, RaTG13 and RmYN02 , , , , , , , .

Figure 3

Comparison of COVID-19-related mortality in non-cancer and cancer patients (A) and the raw data used for the comparison of COVID-19-related mortality in non-cancer and cancer patients (B). Total number of patients are given in the brackets , , , , , -.

Figure 4

Risk factors associated with COVID-19 severity in cancer patients.