COVID-19 pneumonia and immune-related pneumonitis: critical issues on differential diagnosis, potential interactions, and management

ABSTRACT

Introduction

The COVID-19 pandemic occurred amid the cancer immunotherapy revolution. Immune checkpoint inhibitors (ICIs) have become the standard of care for several solid cancers and are associated with peculiar toxicities, including pneumonitis which has similar features to COVID-19 pneumonia.

Areas covered

We summarize the main hallmarks of lung injury induced by ICIs and severe acute respiratory syndrome coronavirus 2 and discuss the critical aspects for differential diagnosis and management. Symptoms and radiological findings are often similar; conversely, treatments are quite different. Furthermore, we focus on potential interactions generating hypotheses that need confirmatory studies.

Expert opinion

All cancer patients treated with immunotherapy should receive screening for SARS-CoV-2. This would improve the diagnosis and management of pneumonia and guide therapeutic choices. Furthermore, clinicians could estimate the risk/benefit of continuing ICI treatment in COVID-19 positive patients. Temporary withdrawal of the immunotherapy treatment pending resolution of viral infection may be a reasonable option in long-responders patients.

KEYWORDS:

• COVID-19
• immune checkpoint inhibitors
• pneumonia
• immune-related Pneumonitis
• immunotherapy
• coronavirus

Authors’ contributions

DS conceived the idea for this paper and coordinated the writing process. MR wrote the original draft and table. MR, FC, DS developed further drafts. FP, AN, ED, AC, BV, and GT critically evaluated and made substantial edits to the manuscript. All authors approved the final version for submissions.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

None declared.