A Case of Small Cell Lung Cancer with COVID-19 Pneumonia during Chemoimmunotherapy

Background. Many patients have contracted coronavirus infectious disease, emerged in 2019 (COVID-19) during lung cancer treatment. However, few reports of COVID-19 infection occurring during chemoimmunotherapy have been published. Case. The patient was a 50-year-old man with advanced small cell lung cancer who was undergoing chemoimmunotherapy. He presented with fever, anorexia, and contracted COVID-19, which led to pneumonia. Patients with lung cancer may be at increased risk for COVID-19 infection, which could worsen their prognosis. However, the patient's COVID-19 pneumonia improved with dexamethasone, and he was able to resume lung cancer treatment. Conclusion. Chemoimmunotherapy may lead to the development of severe disease in patients with COVID-19. COVID-19 pneumonia is often difficult to differentiate from lung injury caused by immune-related adverse events associated with chemoimmunotherapy. Upon the development of pneumonia, we should always suspect COVID-19, diagnose it early, and treat it appropriately. Furthermore, we need to carefully consider the resumption of lung cancer treatment after COVID-19, depending on the severity of residual fibrosis. © 2023 The Japan Lung Cancer Society.

A Case of Small Cell Lung Cancer with COVID-19 Pneumonia during Chemoimmunotherapy.

Background. Many patients have contracted coronavirus infectious disease, emerged in 2019 (COVID-19) during lung cancer treatment. However, few reports of COVID-19 infection occurring during chemoimmunotherapy have been published. Case. The patient was a 50-year-old man with advanced small cell lung cancer who was undergoing chemoimmunotherapy. He presented with fever, anorexia, and contracted COVID-19, which led to pneumonia. Patients with lung cancer may be at increased risk for COVID-19 infection, which could worsen their prognosis. However, the patient's COVID-19 pneumonia improved with dexamethasone, and he was able to resume lung cancer treatment. Conclusion. Chemoimmunotherapy may lead to the development of severe disease in patients with COVID-19. COVID-19 pneumonia is often difficult to differentiate from lung injury caused by immune-related adverse events associated with chemoimmunotherapy. Upon the development of pneumonia, we should always suspect COVID-19, diagnose it early, and treat it appropriately. Furthermore, we need to carefully consider the resumption of lung cancer treatment after COVID-19, depending on the severity of residual fibrosis.Copyright © 2023 The Japan Lung Cancer Society.

COVID-19 in patients with chronic lymphocytic leukemia: a multicenter analysis by the Czech CLL study group.

Patients with chronic lymphocytic leukemia (CLL) have a high risk of poor outcomes related to coronavirus disease 2019 (COVID-19). This multicenter cohort study evaluated the impact of COVID-19 infection on the population of CLL patients in the Czech Republic. Between March 2020 and May 2021, 341 patients (237 males) with CLL and COVID-19 disease were identified. The median age was 69 years (range 38-91). Out of the 214 (63%) patients with the history of therapy for CLL, 97 (45%) were receiving CLL-directed treatment at diagnosis of COVID-19: 29% Bruton tyrosine kinase inhibitor (BTKi), 16% chemoimmunotherapy (CIT), 11% Bcl-2 inhibitor, and 4% phosphoinositide 3-kinase inhibitor. Regarding the severity of COVID-19, 60% pts required admission to the hospital, 21% pts were admitted to the intensive care unit (ICU), and 12% received invasive mechanical ventilation. The overall case fatality rate was 28%. Major comorbidities, age over 72, male gender, CLL treatment in history, CLL-directed treatment at COVID-19 diagnosis were associated with increased risk of death. Of note, concurrent therapy with BTKi compared to CIT was not associated with better outcome of COVID-19.

Would the Addition of Immunotherapy Impact the Prognosis of Patients With Malignant Pericardial Effusion?

Pericardial effusion is a common finding in advanced-stage lung cancer. The presence of malignant cells or drainage of exudate effusion in the pericardial space may cause symptoms of dyspnea, pleuritic chest pain, and syncope. In addition to the difficulty physicians face in the detection and diagnosis of malignant pericardial effusion, treatment may be challenging considering the cancer prognosis and cardiovascular stability of the patient. Despite the availability of several treatment modalities for malignant pericardial effusion, including chemotherapy and surgery, patients with lung cancer historically present with poor prognoses. In addition to lung adenocarcinoma with malignant pericardial effusion, this case was complicated by COVID-19 and malignancy-associated obstructive pneumonia. We present a case of a 64-year-old woman with advanced non-small cell lung carcinoma (NSCLC) with malignant pericardial effusion who, despite testing positive for COVID-19 and having obstructive pneumonia, had favorable outcomes following systemic therapy with combined chemo-immunotherapy.

Agony of choice-selecting chronic lymphocytic leukemia treatment in 2022.

The treatment landscape of chronic lymphocytic leukemia (CLL) has undergone profound change in recent years. Targeted therapies have outnumbered chemotherapy-based treatment approaches demonstrating superior efficacy and tolerability profiles across nearly all CLL patient subgroups in the frontline and relapsed disease treatment setting. Individual selection of these novel agents is rather driven by patients' comorbidities and personal preferences than fitness and age. Given the high amount of currently licensed novel agents in both treatment-naïve as well as relapsed CLL patients and currently limited evidence from comparative clinical trials, clinicians sometimes appear spoilt for choice when selecting optimal therapy. This short review discusses recent clinical trial data focusing on treatment with targeted drugs and aims to help guide CLL treatment selection in individual patients.

Concurrent Lymphoma and COVID-19: Diagnostic and Therapeutic Challenges of High-Grade Lymphoma and COVID-19.

The coronavirus disease 2019 (COVID-19) global pandemic has put an unprecedented strain on cancer care. The initial months were marred by fears of immunocompromised patients becoming opportunistic hosts to this deadly virus. We present a case of newly diagnosed high-grade B-cell lymphoma in a patient with COVID-19 and discuss the diagnostic and therapeutic challenges posed. A 76-year-old female presented with one month of progressive malaise, poor appetite, weight loss, and night sweats. A surveillance COVID-19 polymerase chain reaction (PCR) resulted positive. With strict isolation precautions, the daily focused physical examination masked several key findings including multifocal adenopathy. She developed hypoxic respiratory failure and progressive transaminitis and cytopenias. Image-guided, rather than excisional, biopsy revealed high-grade B-cell lymphoma. Superimposed COVID-19 infection presented multiple challenges, but she completed treatment and achieved remission. Suspicion for underlying malignancy was high. Institutional concerns included obtaining imaging studies and the gold standard excisional tissue biopsy while maintaining acceptable staff exposure. Fortunately, a lymph node core biopsy confirmed the histopathological diagnosis of high-grade B-cell lymphoma. The administration of chemoimmunotherapy (rituximab, cyclophosphamide, doxorubicin, dose-reduced vincristine, and prednisone (R-CHOP)) posed inherent risks, notably, worsening cytopenias and hepatotoxicity. The approach to treatment was further complicated as the interaction of high-grade lymphoma and COVID-19 remained unclear. Medical teams have faced delays executing formerly routine diagnostic studies and formulating timely and appropriate treatment strategies. Careful consideration of risks and benefits must be weighed. A multidisciplinary approach is crucial to successfully treat patients. The relationship between COVID-19 and cancer treatment is yet to be established, and large sample-size studies are required.

Impact of COVID-19 in patients with lymphoid malignancies.

The first cases of coronavirus disease 2019 (COVID-19) were detected in Wuhan, China, in December 2019. Since this time a concerted global effort of research and observational data gathering has meant that a great deal has been learnt about the impact of COVID-19 in patients with lymphoid malignancies. Approximately one-third of patients with lymphoid malignancies who acquire COVID-19 and have it severely enough to require hospital assessment will die from this infection. Major risk factors for a poor outcome are age and co-morbidities, but when these are taken into account lymphoma patients have a slightly greater than 2-fold increased risk compared to the general population. Notably, despite early concerns regarding the particular vulnerability of lymphoma patients due to the immunosuppressive effects of therapy, active treatment, including B-cell depleting agents such as rituximab, do not appear to be associated with an increased risk of a poorer outcome. Indeed, some treatments such as ibrutinib may be beneficial due to their modulation of the potential fatal hyperinflammatory phase of infection. There are risks associated with hemopoietic stem cell transplantation, but the collective experience is that these can be minimized by preventive strategies and that the majority of transplant recipients with COVID-19 infection will survive. Many questions remain including those regarding the outcome of COVID-19 infection in the rarer lymphoid malignancies and the efficacy of COVID-19 vaccines in lymphoma patients. This review aims to discuss these issues and present a summary of the current knowledge of the impact of COVID-19 in lymphoid malignancies.

Association of active oncologic treatment and risk of death in cancer patients with COVID-19: a systematic review and meta-analysis of patient data.

BACKGROUND: Cancer patients suffer from worse coronavirus disease-2019 (COVID-19) outcomes. Whether active oncologic treatment is an additional risk factor in this population remains unclear. Therefore, here we have conducted a systematic review and meta-analysis to summarize the existing evidence for the effect of active oncologic treatment on COVID-19 outcomes. METHODS: Systematic search of databases (PubMed, Embase) was conducted for studies published from inception to July 1, 2020, with a subsequent search update conducted on 10 October 2020. In addition, abstracts and presentations from major conference proceedings (ASCO, ESMO, AACR) as well as pre-print databases (medxriv, bioxriv) were searched. Retrospective and prospective studies reporting clinical outcomes in cancer patients with laboratory confirmation or clinical diagnosis of COVID-19 and details of active or recent oncologic treatment were selected. Random-effects model was applied throughout meta-analyses. Summary outcome measure was the pooled odds ratio (OR) of death for active cancer therapy versus no active cancer therapy for each of the following modalities: recent surgery, chemotherapy, targeted therapy, immunotherapy, or chemoimmunotherapy. RESULTS: Sixteen retrospective and prospective studies (3558 patients) were included in the meta-analysis. Active chemotherapy was associated with higher risk of death compared to no active chemotherapy (OR, 1.60, 95% CI, 1.14-2.23). No significant association with risk of death was identified for active targeted therapy, immunotherapy, chemoimmunotherapy, or recent surgery. Meta-analysis of multivariate adjusted OR of death for active chemotherapy was consistently associated with higher risk of death compared to no active chemotherapy (OR, 1.42, 95% CI, 1.01-2.01). CONCLUSIONS: Active chemotherapy appears to be associated with higher risk of death in cancer patients with COVID-19. Further research is necessary to characterize the complex interactions between active cancer treatment and COVID-19.