Case Report: Adequate T and B Cell Responses in a SARS-CoV-2 Infected Patient After Immune Checkpoint Inhibition.

After the COVID-19 outbreak, non-evidence based guidelines were published to advise clinicians on the adjustment of oncological treatment during this pandemic. As immune checkpoint inhibitors directly affect the immune system, concerns have arisen about the safety of immunotherapy during this pandemic. However, data on the immune response in oncology patients treated with immunotherapy are still lacking. Here, we present the adaptive immune response in a SARS-CoV-2 infected patient who was treated with immune checkpoint inhibitors for advanced renal cell cancer. To evaluate the immune response in this patient, the number of T cells and their major subsets were measured according to expression of markers for co-signalling, maturation, and chemotaxis at baseline, during therapy, and during the SARS-CoV-2 infection. In addition, plasma samples were analyzed for IgM and IgG antibodies and the ability of these antibodies to neutralise SARS-CoV-2. Despite several risk factors for an impaired immune response to SARS-CoV-2, both T- and B-cell responses were observed. Moreover, after treatment with immune checkpoint inhibitors, a sufficient cellular and humoral immune response was achieved in this SARS-CoV-2 infected patient. These findings warrant renewed discussion on withholding of immune checkpoint inhibitors during an ongoing COVID-19 pandemic.

Dutch oncology COVID-19 Consortium (DOCC): Outcome of COVID-19 in patients with cancer in a nationwide cohort study

Background: The coronavirus disease 2019 (COVID-19) pandemic is having significant impact on oncological care (Joode et al, Eur J Cancer 2020;136:132-139) and patients with cancer might have an increased risk for severe outcome of COVID-19. In order to identify risk factors associated with a worse outcome of COVID-19, a nationwide registry was developed for patients with cancer and COVID-19. Methods: This ongoing multicentre nationwide observational cohort study was designed as a quality of care registry and is executed by the Dutch Oncology COVID-19 Consortium (DOCC), a collaboration of oncology physicians in the Netherlands. A questionnaire was developed to collect pseudonymised patient data on patients’ characteristics, cancer diagnosis, cancer treatment, and outcome of COVID-19. All patients with COVID-19 and a cancer diagnosis or cancer treatment in the past 5 years were eligible for inclusion. Results: To date, > 600 cancer patients diagnosed with COVID-19 have been registered by 45 Dutch hospitals. Data of 442 registered patients with at least 4 weeks follow-up were cleaned and 351 patients could be included for the first analyses. The main cancer diagnoses were non-small cell lung cancer (13.4%), breast cancer (13.4%), and chronic lymphocytic leukaemia (8.8%). Overall, 114 (32.3%) out of 351 patients with cancer died from COVID-19. In multivariate analyses, age ≥ 65 years (p < 0.001), male gender (p = 0.035), prior or other malignancy (p = 0.045), and active diagnosis of haematological malignancy (p = 0.046) or lung cancer (p = 0.003) were independent risk factors for a fatal outcome of COVID-19. In a subgroup analysis of patients with active malignancy, the risk for a fatal outcome was mainly determined by tumour type (haematological malignancy or lung cancer) and age (≥ 65 years). Conclusions: The findings in this registry indicate that patients with a haematological malignancy or lung cancer have an increased risk of a worse outcome of COVID-19. During the ongoing COVID-19 pandemic, these vulnerable patients should avoid exposure to SARS-CoV-2, whereas treatment adjustments and prioritizing vaccination, when available, should also be considered. Legal entity responsible for the study: Erasmus Medical Center. Funding: Dutch Cancer Society. Disclosure: D.W. Dumoulin: Honoraria (self), Speakers fee: MSD;Honoraria (self), Speakers fee : Roche;Honoraria (self), Speakers fee: Astazeneca;Honoraria (self), Speakers fee: BMS;Honoraria (self), Speakers fee: Novartis;Honoraria (self), Speakers fee: Pfizer. H.M. Westgeest: Honoraria (self): Astellas;Honoraria (self): Roche;Travel/Accommodation/Expenses: Ipsen. L.E.L. Hendriks: Advisory/Consultancy, Mentorship program with key opinion leaders: funded by AstraZeneca: AstraZeneca;Honoraria (self), Educational webinars: Quadia;Research grant/Funding (institution): AstraZeneca;Advisory/Consultancy, Paid to institution: Eli Lilly;Advisory/Consultancy, Paid to institution: Roche Genentech;Advisory/Consultancy, Paid to institution: Pfizer;Advisory/Consultancy, Advisory board and speakers fee all paid to institution: MSD;Advisory/Consultancy, Paid to institution: Takeda;Leadership role, Local PI of pharma initiated research: AstraZeneca;Leadership role, Local PI of pharma initiated research: Novartis;Leadership role, Local PI of pharma initiated research: BMS;Leadership role, Local PI of pharma initiated research: MSD / Merck;Leadership role, Local PI of pharma initiated research: GSK;Leadership role, Local PI of pharma initiated research: Takeda;Leadership role, Local PI of pharma initiated research: Blueprint Medicines;Leadership role, Local PI of pharma initiated research: Roche Genentech;Advisory/Consultancy, Paid to institution: Amgen;Advisory/Consultancy, Paid to institution: Boehringer Ingelheim;Advisory/Consultancy, Paid to institution: BMS;Advisory/Consultancy, Travel/Accommodation/Expenses, Advisory board paid to institution: Roche Genentech;Travel/Accommodation/Expenses: BMS;Research grant/Funding (institution): Roche Genentech;R search grant/Funding (institution): Boehringer Ingelheim. A-M.C. Dingemans: Honoraria (self): Roche;Honoraria (self): Eli Lilly;Honoraria (self): Boehringer Ingelheim;Honoraria (self): Pfizer;Honoraria (self): BMS;Honoraria (self): Novartis;Honoraria (self): Takeda;Honoraria (self): PharmaMar;Advisory/Consultancy, non financial support: AbbVie;Research grant/Funding (institution): BMS;Research grant/Funding (institution): Amgen. A.A.M. Van der Veldt: Honoraria (institution), Advisory/Consultancy: BMS;Honoraria (institution), Advisory/Consultancy: MSD;Honoraria (institution), Advisory/Consultancy: Pfizer;Honoraria (institution), Advisory/Consultancy: Sanofi;Honoraria (institution), Advisory/Consultancy: Eisai;Honoraria (institution), Advisory/Consultancy: Ipsen;Honoraria (institution), Advisory/Consultancy: Roche;Honoraria (institution), Advisory/Consultancy: Novartis;Honoraria (institution), Advisory/Consultancy: Merck;Honoraria (institution), Advisory/Consultancy: Pierre Fabre. All other authors have declared no conflicts of interest.

Impact of the coronavirus disease 2019 pandemic on cancer treatment: the patients' perspective.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has inevitable consequences for medical care of patients without COVID-19. To assess the impact of this pandemic on oncological care, a nationwide survey was conducted among patients with cancer in the Netherlands. METHODS: The patients' perspective on oncological care was investigated using an online survey between March 29th 2020 and April 18th 2020. The survey consisted of 20 questions on four topics: patients' characteristics, contact with the hospital, consequences of the COVID-19 pandemic and concerns about COVID-19. RESULTS: Five thousand three hundred two patients with cancer completed this nationwide survey. Overall, 30% of patients reported consequences for their oncological treatment or follow-up. In the majority of cases, this resulted in conversion from hospital visit to consultation by phone or video. The most frequently adjusted treatments were chemotherapy (30%) and immunotherapy (32%). Among patients with delay and discontinuation of treatment, 55% and 63% of patients, respectively, were (very) concerned about these consequences of the COVID-19 pandemic. Consequences were independent of regional differences in COVID-19 incidence. However, patients in regions with high COVID-19 incidence were significantly more concerned. CONCLUSION: This is the first study investigating perspectives of patients with cancer during the COVID-19 pandemic. The study demonstrates the significant impact of the COVID-19 crisis on oncological care, indicating the need for psycho-oncological support during this pandemic.