Commentary: Should all cancer patients be tested for COVID-19 before each chemotherapy cycle?

Cancer patients under active chemotherapy are more vulnerable to coronavirus disease 19 (COVID-19). There are still some controversies regarding routine polymerase chain reaction testing of asymptomatic cancer patients before chemotherapy cycles. Despite a lack of data, Al-Shamsi et al. showed higher COVID-19 positivity rate among asymptomatic cancer patients. Furthermore, mortality rate was higher in this group of patients. There is no high evidence-based recommendation from the cancer societies for testing asymptomatic patients before each chemotherapy cycle. In this commentary, we assessed the current publications and guidelines regarding this issue.

A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19.

BACKGROUND: The COVID-19 pandemic hit all over the world, and cancer patients are more vulnerable for COVID-19. The mortality rate may increase up to 25% in solid malignancies. In parallel to increased mortality rates among cancer patients, safety concerns regarding cancer treatment has increased over time. However, there were contradictory results for the cancer treatment during pandemic. In this study, we assessed the effect of cancer treatment on the severity of COVID-19. METHODS: The MEDLINE database was searched on September 01, 2020. Primary end-points were severe disease and death in the cancer patients treated within the last 30 days before COVID-19 diagnosis. Quality of included studies was assessed by Newcastle-Ottawa scale. The generic inverse-variance method was used to calculate odds ratios (ORs) for each outcome. RESULTS: Sixteen studies were included for this meta-analysis. Chemotherapy within the last thirty days before COVID-19 diagnosis increased the risk of death in cancer patients after adjusting for confounding variables (OR: 1.85; 95% confidence interval: 1.26-2.71). However, severe COVID-19 risk did not increase. Furthermore, targeted therapies, immunotherapy, surgery and radiotherapy did not increase the severe disease and death risk in cancer patients with COVID-19. CONCLUSION: Chemotherapy increased the risk of death from COVID-19 in cancer patients. However, there was no safety concern for immunotherapy, targeted therapies, surgery and radiotherapy.

Clinical course of COVID-19 infection in elderly patient with melanoma on nivolumab

Outbreak of the new type coronavirus infection, known as coronavirus infection 2019 (COVID-19), has begun in December 2019, in Wuhan, China. As of today, 3 April 2020, 972,640 people affected and 50,325 people died from Severe Acute Respiratory Syndrome-Coronavirus 2. There is not any standard treatment for coronavirus infection 2019;however, there are promising data for hydroxychloroquine and some anti-retroviral drugs. Programmed death-1 (PD-1)/programmed death ligand-1 (PDL-1) pathway is an important target for the cancer immunotherapy. However, there is a robust pre-clinical and clinical data regarding inhibitor effect of this pathway on the acute or chronic viral infections. Thus, blockade of this pathway may lead to an anti-viral effect and decrease viral load. Here, we report the clinical course of coronavirus infection 2019 infection of a patient in whom older aged, having multiple co-morbidities, and taking nivolumab for metastatic malignant melanoma. In contrast to her older age, comorbidities, and cancer diagnosis, she was in a good condition, and there was also no pneumonia finding. We think that this good clinical course of coronavirus infection 2019 infection may be related to blockade of PD-1/PDL-1 pathway with nivolumab. It is impossible to say that blockade of PD-1/PDL-1pathway is a treatment option for COVID-19;however, we want to share our experience.