Abstract CT405: Experience in using oncology drugs in patients with COVID-19
Authors: Ascierto Paolo A. 
Published: September 2020

In relation to the spread of severe acute respiratory syndrome coronavirus 2 (SARS CoV2), oncologists need to face some difficult situations. First of all, safety considerations about cancer patients during this pandemia. To keep safe both patients and healthy workers is the most important rule. In our daily practice we adopted a specific policy about the conduct of our clinical managements of melanoma patients, in order to minimise the risk of any potential exposure. We are prioritizing patients, according to the kind of treatment and the stage of disease. In order to avoid any gathering condition which could increase the risk of infection for patients, we are optimizing access about adjuvant treatment, considering of high priority the higher risk patients, privileging longer infusion schedule of treatment for immunotherapy and/or selecting patients with BRAF mutation for starting target therapy. Metastatic patients have the highest priority, and nothing changed in their daily management except for preferring, when possible, the longer schedule of treatment in order to reduce the access in the hospital. The enrolment in clinical trials is on hold and the patients still in treatment inside clinical study are managed in the respect of GCPs as well as possible.

Some additional issues are side effects in patients on treatment with target therapy and immunotherapy. About target therapy (especially dabrafenib and trametinib), patients who develop fever higher than 37.5 without resolving after discontinuation, should perform COVID test before to restart the treatment. Patients on treatment with immunotherapy who show pneumonitis at CT scan (even without fever), should perform COVID test before start steroids.

Immuno-oncologists have an important experience in the management of immuno-related adverse events. The hyperactivation of immune system due to the immunotherapy strategies can develop some conditions which need of immuno-suppressive drugs to reduce the harmful immune reaction. Since the acute respiratory stress syndrome COVID-19 related seems to occur from an excess of cytokine production, we focused our attention on the cytokines storm which probably lead to ARDS by COVID-19 and how to prevent or treat it. We know very well the Cytokine Release Syndrome (CRS), one of the most prominent and well described toxicity from chimeric antigen receptor T cell therapy (CAR-T), as well as from some bispecific antibodies. In particular, we know the key role played by IL-6 in the pathogenesis of these kind of hyperinflammation syndromes.

Considering elevated serum concentration of IL-6 and CPR in patients admitted in ICUs department, we started to use monoclonal antibodies against IL6, above all tocilizumab. In Italy we started on 19th of March a phase II study (NCT04317092) which enrolled 330 patients in 24 hours, with the ability of tocilizumab to reduce the one-month mortality rate as main endpoint. Results should be reported at the end of April. Other drugs active in reducing the CRS are at moment in clinical trial or expanded access program like JAK inhibitors, complement inhibitors, toll like receptor inhibitors and others.

Citation Format: Paolo A. Ascierto. Experience in using oncology drugs in patients with COVID-19 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT405.