Case Report: Clinical Management of a Patient With Metastatic Non-Small Cell Lung Cancer Newly Receiving Immune Checkpoint Inhibition During Symptomatic COVID-19.

Abstract

Effects of initiation of programmed-death-protein 1 (PD1) blockade during active SARS-CoV-2 infection on antiviral immunity, COVID-19 course, and underlying malignancy are unclear. We report on the management of a male in his early 40s presenting with highly symptomatic metastatic lung cancer and active COVID-19 pneumonia. After treatment initiation with pembrolizumab, carboplatin, and pemetrexed, the respiratory situation initially worsened and high-dose corticosteroids were initiated due to suspected pneumonitis. After improvement and SARS-CoV-2 clearance, anti-cancer treatment was resumed without pembrolizumab. Immunological analyses with comparison to otherwise healthy SARS-CoV-2-infected ambulatory patients revealed a strong humoral immune response with higher levels of SARS-CoV-2-reactive IgG and neutralizing serum activity. Additionally, sustained increase of Tfh as well as activated CD4+ and CD8+ T cells was observed. Sequential CT scans showed regression of tumor lesions and marked improvement of the pulmonary situation, with no signs of pneumonitis after pembrolizumab re-challenge as maintenance. At the latest follow-up, the patient is ambulatory and in ongoing partial remission on pembrolizumab. In conclusion, anti-PD1 initiation during active COVID-19 pneumonia was feasible and cellular and humoral immune responses to SARS-CoV-2 appeared enhanced in our hospitalized patient. However, distinguishing COVID-19-associated changes from anti-PD1-associated immune-related pneumonitis posed a considerable clinical, radiographic, and immunologic challenge.

• Authors: Sibylle C Mellinghoff, Kanika Vanshylla, Christine Dahlke, Marylyn M Addo, Oliver A Cornely, Florian Klein, Thorsten Persigehl, Jan Rybniker, Henning Gruell, Paul J Bröckelmann
• Journal: Frontiers in immunology (Front Immunol) Vol. 12 Pg. 798276 ( 2021) ISSN: 1664-3224 [Electronic] Switzerland
• PMID: 34987520 (Publication Type: Case Reports, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Mellinghoff, Vanshylla, Dahlke, Addo, Cornely, Klein, Persigehl, Rybniker, Gruell and Bröckelmann.

Chemical References

• Adrenal Cortex Hormones
• COVID-19 Vaccines
• Immune Checkpoint Inhibitors

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adult
• CD8-Positive T-Lymphocytes (drug effects, immunology, virology)
• COVID-19 (complications, immunology)
• COVID-19 Vaccines (administration & dosage, immunology)
• Carcinoma, Non-Small-Cell Lung (complications, drug therapy, immunology)
• Humans
• Immune Checkpoint Inhibitors (therapeutic use)
• Immunity, Humoral (drug effects, immunology)
• Lung Neoplasms (complications, drug therapy, immunology)
• Male
• Neoplasm Metastasis
• Pneumonia (immunology, prevention & control, virology)
• SARS-CoV-2 (drug effects, immunology)
• COVID-19 Drug Treatment