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. 2021 Sep;21(9):1173-1179.
doi: 10.1080/14712598.2021.1887131. Epub 2021 Feb 17.

Immune checkpoint inhibition in COVID-19: risks and benefits

Parmida Sadat Pezeshki  1   2 , Nima Rezaei  1   2   3
Affiliations

Immune checkpoint inhibition in COVID-19: risks and benefits

Parmida Sadat Pezeshki et al. Expert Opin Biol Ther. 2021 Sep.

Abstract

Introduction: Immune checkpoint inhibition (ICI) is a novel cancer immunotherapy, which is administered in patients with metastatic, refractory, or relapsed solid cancer types. Since the initiation of the Coronavirus Disease 2019 (COVID-19) pandemic, many studies have reported a higher severity and mortality rate of COVID-19 among patients with cancer in general.

Areas covered: The immunomodulatory effects of ICI can modify the patients' immune system function in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There is controversy over whether the severity of COVID-19 in cancer patients who previously received ICI compared to other patients with cancer has increased. There is evidence that the upregulation of immune checkpoint molecules in T cells, lymphopenia, and inflammatory cytokine secretion are associated with the severity of COVID-19 symptoms.

Expert opinion: ICI can interrupt the T cell exhaustion and depletion by interrupting the inhibitory signaling of checkpoint molecules in T cells, and augments the immune system response in COVID-19 patients with lymphopenia. However, ICI may also increase the risk of cytokine release syndrome. ICI can be considered not only as a cancer immunotherapy but also as immunotherapy in COVID-19. More studies are needed to assess the safety of ICI in COVID-19 patients with or without cancer.

Keywords: COVID-19; cytokine release syndrome; immune Checkpoint Inhibition; immunotherapy; lymphopenia; severe acute respiratory syndrome coronavirus 2.

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Figures

Figure 1.
Figure 1.
Immunological manifestations of COVID-19
Figure 2.
Figure 2.
Risks and benefits of ICI administration in patients with COVID-19
See this image and copyright information in PMC

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