Impact of treatment delay due to the pandemic of COVID-19 on the efficacy of immunotherapy in head and neck cancer patients.

Immunotherapy has been a new standard for recurrent/metastatic head and neck cancers (R/M HNC). One of the prominent characteristics of cancer immunotherapy is the induction of immune memory followed by endured treatment response. However, whether and how a treatment delay would impact on the efficacy of immunotherapy has not been well determined. During the outbreak of COVID-19, a number of cancer patients in Wuhan, the epicenter of the pandemic in China, had experienced long-lasting city lockdown and delay of immunotherapies. Here, we retrospectively analyzed 24 HNC patients treated with immune checkpoint inhibitors in our cancer institute prior to the outbreak of COVID-19 who were re-evaluated after the restoration of regular medical care. Of these 24 patients, 10 patients had achieved complete response (CR) or partial response (PR), 12 patients had achieved stable disease (SD), and 2 patients had received just one cycle treatment without efficacy evaluation before treatment delay. The median delay was 3.75 months (range 1.73-8.17 months). Re-evaluation after treatment delay revealed that ten patients (10/10) who achieved CR or PR, two patients (2/2) who received just one cycle treatment without efficacy evaluation and seven patients (7/12) who achieved SD before outbreak of COVID-19 maintained tumor response after treatment delay. Among the rest five patients who had achieved SD, four patients were re-evaluated as progressive disease (PD) due to treatment delay and one patient died after treatment interruption without re-evaluation. Our results from a small cohort of R/M HNC patients showed that treatment delay of three to four months might have mild, if any, impact on the efficacy of immunotherapy for patients with controlled disease.

Complete and enduring response in an elderly patient with repeated recurrent gingival squamous cell carcinoma treated by combined toripalimab and single agent chemotherapy: a case report.

Combined immune checkpoint inhibitor with platinum-based doublet chemotherapy brought about significant improvement in overall survival as the first line treatment in metastatic and recurrent head and neck cancer patients. However, in elderly patients with relatively poor performance status, these regimens might not be well tolerated. Therefore, we evaluated the safety and effect of combined immunotherapy and single agent chemotherapy in an elderly patient with recurrent head and neck squamous cell carcinoma. A 78-year-old male patients with a repeatedly recurrent gingival squamous cell carcinoma was admitted in our institute. Previously this patient underwent two consecutive surgical resections of recurrent tumors before the second rapid recurrence that resulted in extended tumor mass and lymph node metastasis. As the patient was in a relatively poor performance status (performance status =2), immunotherapy with PD-1 antibody (Toripalimab) combined with single agent chemotherapy (two cycle with albumin-bound paclitaxel and then six cycles with gemcitabine) was administrated, which led to clinical complete response after 8 cycles of treatment. The patient continued 4 cycles of maintenance immunotherapy with Toripalimab until the outbreak of the coronavirus disease 2019. The treatment was well tolerated and the patient remained free from disease until the last follow up by June 2020, 16 months after the initiation of treatment. The success in this case indicated that the combination of anti-PD-1 antibody and single chemotherapy agent may also be effective as well as safe in elderly patients with recurrent head and neck squamous cell carcinoma.

Outcomes of novel coronavirus disease 2019 (COVID-19) infection in 107 patients with cancer from Wuhan, China.

BACKGROUND: Patients with cancer have a higher risk of coronavirus disease 2019 (COVID-19) than noncancer patients. The authors conducted a multicenter retrospective study to investigate the clinical manifestations and outcomes of patients with cancer who are diagnosed with COVID-19. METHODS: The authors reviewed the medical records of hospitalized patients who were treated at 5 hospitals in Wuhan City, China, between January 5 and March 18, 2020. Clinical parameters relating to cancer history (type and treatment) and COVID-19 were collected. The primary outcome was overall survival (OS). Secondary analyses were the association between clinical factors and severe COVID-19 and OS. RESULTS: A total of 107 patients with cancer were diagnosed with COVID-19, with a median age of 66 years (range, 37-98 years). Lung (21 patients; 19.6%), gastrointestinal (20 patients; 18.7%), and genitourinary (20 patients; 18.7%) cancers were the most common cancer diagnoses. A total of 37 patients (34.6%) were receiving active anticancer treatment when diagnosed with COVID-19, whereas 70 patients (65.4%) were on follow-up. Overall, 52.3% of patients (56 patients) developed severe COVID-19; this rate was found to be higher among patients receiving anticancer treatment than those on follow-up (64.9% vs 45.7%), which corresponded to an inferior OS in the former subgroup of patients (hazard ratio, 3.365; 95% CI, 1.455-7.782 [P = .005]). The detrimental effect of anticancer treatment on OS was found to be independent of exposure to systemic therapy (case fatality rate of 33.3% [systemic therapy] vs 43.8% [nonsystemic therapy]). CONCLUSIONS: The results of the current study demonstrated that >50.0% of infected patients with cancer are susceptible to severe COVID-19. This risk is aggravated by simultaneous anticancer treatment and portends for a worse survival, despite treatment for COVID-19.