Immune checkpoint inhibition in COVID-19: risks and benefits

ABSTRACT

Introduction

Immune checkpoint inhibition (ICI) is a novel cancer immunotherapy, which is administered in patients with metastatic, refractory, or relapsed solid cancer types. Since the initiation of the Coronavirus Disease 2019 (COVID-19) pandemic, many studies have reported a higher severity and mortality rate of COVID-19 among patients with cancer in general.

Areas covered

The immunomodulatory effects of ICI can modify the patients’ immune system function in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There is controversy over whether the severity of COVID-19 in cancer patients who previously received ICI compared to other patients with cancer has increased. There is evidence that the upregulation of immune checkpoint molecules in T cells, lymphopenia, and inflammatory cytokine secretion are associated with the severity of COVID-19 symptoms.

Expert opinion

ICI can interrupt the T cell exhaustion and depletion by interrupting the inhibitory signaling of checkpoint molecules in T cells, and augments the immune system response in COVID-19 patients with lymphopenia. However, ICI may also increase the risk of cytokine release syndrome. ICI can be considered not only as a cancer immunotherapy but also as immunotherapy in COVID-19. More studies are needed to assess the safety of ICI in COVID-19 patients with or without cancer.

KEYWORDS:

• COVID-19
• cytokine release syndrome
• lymphopenia
• immunotherapy
• immune Checkpoint Inhibition
• severe acute respiratory syndrome coronavirus 2

Article Highlights

• Immune checkpoint inhibitors provide inhibitory signals in T cells and maintain immune-tolerance.

• The expression of immune checkpoint receptors or their ligands is upregulated during some malignancies as well as acute or chronic infections that leads to evasion of the tumor cells or pathogens from immune surveillance.

• Upregulation of immune checkpoint receptors is reported in COVID-19, which is associated with lymphopenia and T cell exhaustion and subsequently worse prognosis.

• Most of the studies report no additional risk of COVID-19 infection or severity in patients with cancer who have recently received immune checkpoint inhibition therapy.

• Immune checkpoint inhibition can be used as a potential therapeutic approach in COVID-19 patients with lymphopenia.

• Further studies are needed to investigate the potential risks and benefits of Immune checkpoint inhibition in COVID-19 patients.

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

This paper is not funded.