Cancer Immunotherapy for COVID-19: 'Extraordinary Times Call for Extraordinary Measures'

While there is little data on the coronavirus disease 2019 (COVID-19), researchers and clinicians are noticing some similarities between patients with COVID-19—related pneumonitis and patients with cancer who experience immune checkpoint inhibitor (ICI)-induced pneumonitis, namely “ground glass” infiltrative appearance on CT scans and elevated IL-6 levels, according to the Society for Immunotherapy in Cancer (SITC).¹

“Many of us have experience with the administration of immune-modulatory agents, which is why the cancer immunotherapy community is poised to contribute to the current fight against COVID-19,” SITC said in a statement.

According to research published last week in the Lancet, there is a subgroup of patients with the virus who might have a cytokine storm syndrome.² Additionally, an article from European Radiology states that patients with COVID-19 tend to have high levels of C-reactive protein (CRP) and IL-6.³

With those findings in mind, researchers suspect that IL-6 or IL-6 receptor blocking antibodies used in cancer treatment—such as tocilizumab (Actemra), sarilumab (Kevzara), and siltuximab (Sylvant) —may be useful in treating patients with COVID-19.

The FDA already gave an OK for a clinical trial of tociizumab for COVID-19 pneumonia.

“These agents could be used on easily and immediately available compassionate use protocols that could be approved on an emergency basis by all IRBs around the world for critically ill patients with COVID-19-induced hypoxia. Tocilizumab also is already FDA-approved to manage cytokine release syndrome (CRS) in patients receiving CAR T-cell therapy,” SITC said.

SITC mentioned that while there is a lack of definitive data showing that IL-6 receptor blockade benefits patients with COVID-19, there should still be efforts to make these treatments available for use on a compassionate basis to patients hospitalized and crucially ill with the virus.

“Even if the primary impact of a single dose of these drugs is to accelerate recovery and get patients off ventilator support and out of the ICU more rapidly, this could significantly decompress our severely over-burdened healthcare systems,” the statement said.

The worldwide pandemic has been ravaging the healthcare system, with many hospitals facing shortages of personal protective equipment (PPE) for nurses, doctors, and other clinicians.

“A simple compassionate use protocol could be assembled from existing templates, and all efforts should be made for emergency approval of the use of IL-6 receptor blocking antibodies by local institutional review boards within 24 hours of the request being made. Additionally, consideration should be given by pharma and biotech to redirect the use of facilities and increase personnel involved in drug manufacturing and those serving as liaisons to the frontlines to facilitate drug availability,” SITC said.

“Extraordinary times call for extraordinary measures, and SITC calls on all involved, including pharmaceutical sponsors, health authorities and IRBs, to continue to move swiftly and creatively to respond and unite in removing barriers to provide our patients with care.”

References

• Society for Immunotherapy in Cancer. SITC Statement on anti-IL-6/IL-6R for COVID-19. March 24, 2020. https://www.sitcancer.org/research/covid-19-resources/il-6-editorial. Accessed March 26, 2020.
• Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression, The Lancet, 2020, ISSN 0140-6736,https://doi.org/10.1016/S0140-6736(20)30628-0.
• Ye, Z., Zhang, Y., Wang, Y. et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol (2020). https://doi.org/10.1007/s00330-020-06801-0

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