Cancer treatments such as chemotherapy, biologics, and immunotherapy appear to alter a patient’s immune response to COVID-19 and reduce the severity of the infection if these patients become infected. Small-scale study suggests.
The team compares the response to SARS-CoV-2 virus in groups of aggressively treated cancer patients to those seen in healthcare professionals, suggesting different inflammatory responses to the virus in the two groups. We found a difference in immune cell profile. The sample size was small, but the difference was noticeable.
Research Published online Today’s journal cancer.
The hypothesis is that cancer patients are unable to develop a strong inflammatory response to COVID-19 due to treatment-related changes to the immune system, senior authors explain. Elit I — Ahalon Head of Oncology at Rambam Health Care Campus in Haifa, Israel, MD, PhD.
As a result, cancer patients undergoing treatment may be less susceptible to the “cytokine storm” response caused by an overly strong immune response to the virus, which is a significant part of the morbidity and mortality seen in COVID-19. Contribute. Infected patient.
Experts sought comment and warned that the numbers in this study were too small to draw conclusions, but said the theory was “biologically plausible.”
Wrong assumption?
“At the beginning of the pandemic, everyone was told that there were some high-risk populations of COVID-19. They are predisposed because cancer patients are immunosuppressed and susceptible to other viruses. We will also get COVID-19, which was supposed to be. ” Medscape Medical News..
“Therefore, that assumption was mostly transformed into a panic situation, so we had to see if this was true. Cancer patients want to be treated worried that they might get sick with COVID-19. “No,” she added.
“However, the incidence of COVID-19 remains the same, at least in asymptomatic patients, compared to healthcare professionals in our sample of cancer patients, with differences in immune cell profiles between these two groups. I found out that it was, as well, “commented Ben Ahalon.
“This difference can lead to different inflammatory reactions [to COVID-19], This needs further study, “she added.
Survey details
Importantly, the investigation was conducted between the end of March and the beginning of June, so it only reflects what was being done in Israel during that period, as Ben Ahalon emphasized. Meanwhile, Israel was completely blocked.
Serology shows 164 cancer patients receiving aggressive intravenous treatment (92 women, median age 63 years) and 107 health care workers at the Lanvin Healthcare Campus Oncology Center (88 women, age). The median was 41 years old). Approximately 60% of the patient group had metastatic disease and the remaining 40% had local cancer.
Almost three-quarters of cancer patients received chemotherapy, one-third received biological therapy, and one-quarter received immunotherapy. The authors point out that some patients received multiple treatments.
Blood was collected three times — late March, early May, and early June. The researchers said that only serology was performed, not PCR.
Ben Ahalon emphasized that Israel was completely detained during the study, so these cancer patients and health care workers had nowhere else to go and moved only between their homes and treatment centers.
The results of the study showed that few patients were actually exposed during the study, suggesting that they were self-isolated (“P <.01). The hospital has mandated universal facial masking and temperature checks since mid-April.
Asymptomatic cases
“During the study, no symptomatic cases of COVID-19 were recorded among recruited participants and in the general patient population or health care cohort of the cancer center,” the researchers said. Says.
Serological tests showed positive titers of anti-SARS-CoV-2 IgG (IgG +) in 4 of 164 cancer patients (2.4%) and 2 of 107 healthcare workers (1.9%) Was confirmed.
In contrast, anti-SARS-CoV-2 IgM and IgA were not detected in all serum samples in 3 tests.
“Of the six participants with positive results, only one had COVID19-related comorbidities,” they added.
CyTOF (time-of-flight cytometry) analysis, which depicts individual cells of the immune system, showed differences between the two groups.
Two health care workers who had SARS-CoV-2 IgG + had about 90% reduction in bone marrow cells compared to those who had SARS-CoV-2 IgG –.
In contrast, studies have shown that bone marrow cell loss is about 50% smaller in 4 cancer patients with SARS-COV-2 IgG + compared to cancer patients with SARS-CoV-2 IgG– The authors report.
“We had a very small sample size,” admitted Ben Ahalon. “But even with this minimal sample size, we saw different patterns in the immune profile. [between the two groups] We also looked at how COVID-19 affected healthcare professionals and found that patterns were completely different, especially in myeloid cells, compared to cancer patients, “she added. It was.
Changes in the proportion of immune cells between healthcare professionals and cancer patients who were SARS-CoV-2 IgG were also “substantial” for natural killer cells, B cells, dendritic cells, and more immunocyte. The composition changes the susceptibility of cancer patients to the virus when compared to healthcare professionals, “the researchers suggest.
Asymptomatic cases
Very surprisingly, no clinically ill cases of COVID-19 have been recorded in the 8500 patients who visited the Rambam Tumor Center between December 2019 and May 2020.
In addition, one of the 228 health care workers at the Cancer Center did not develop symptomatological COVID-19 infection at the same time interval.
Ben Ahalon also said, “You need to wear a mask and take the same precautions to keep you socially distant, but COVID-19 infection in cancer patients is not fatal, so you need to follow your usual treatment schedule. There is, “Ben-Aharon emphasized.
“The risk for cancer patients is not from COVID, but from their cancer, and doctors should treat it,” she said.
The theory is “biologically plausible”
When asked to comment on the study, MBBS, PhD, and clinical lecturer Alvin Lee of the University College London, UK, said the number of studies was still too small to draw clear conclusions from previous data. I felt that.
“Researchers have detected antibodies [to the SARS-CO-V-2 virus] It’s in the blood, but I don’t know how many days have passed since the infection, so it’s still quite early. “
However, Lee also felt that it was “biologically plausible” that cancer treatment could affect a patient’s immune profile.
As a member of the project management group for the UK Coronavirus Cancer Monitoring Project, Lee et al. Recently Reported the analysis results 800 cancer patients and symptomatological COVID-19 treated from March 18 to April 26 in the Cancer Center Network.
About half (52%) of these patients had a mild infection course.
Approximately 28% of the group died, but the risk of death is the patient’s aging rate (odds ratio) [OR], 9.42); Being male (OR, 1.67), and the presence of other comorbidities High blood pressure (Or 1.95) and cardiovascular disease (or 2.32).
In addition, after adjusting for age, gender, and comorbidities, “the last four weeks of chemotherapy did not significantly affect the mortality rate of COVID-19 disease compared to cancer patients who did not receive recent chemotherapy. Lee et al. Reported.
Lee said Medscape Medical News This particular cohort of cancer patients appeared to have a better prognosis than many other patients because they were expected to benefit most from anticancer treatment.
“So I think this may be the reason why I didn’t see the increased risk of death separately. [other now well established] COVID-19 Risk Factors for Death “.
“But it is certainly plausible that cancer treatment affects the immune profile of cancer patients, which can affect the outcome of patients infected with COVID-19,” he said.
The study’s co-authors Ben Ahalon and Lee have not revealed the relevant financial relationship.
cancer. Published online on August 2 3 , 2020. Full text
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