COVID-19 and Lung Cancer: Should ALK/ROS1 Inhibitor Therapy Be Continued?
Posted: Wednesday, June 10, 2020
International panels recommended that anticancer treatments be delayed or suspended following the outbreak of the pandemic acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A Letter to the Editor, published in the European Journal of Cancer, evaluated two patients with non–small cell lung cancer (NSCLC) who continued targeted therapy with ALK/ROS1 inhibitors in the presence of suspected COVID-19 interstitial pneumonia—they both recovered. However, Alessandro Leonetti, MD, of the University Hospital of Parma, Italy, and colleagues noted that definitive conclusions on the disease and treatment could not be drawn from this limited experience.
The researchers presented two patients with NSCLC suspected of being infected with COVID-19 in early 2020. Both patients maintained targeted therapy with ALK/ROS1 inhibitors with interstitial pneumonia. The first case featured a 62-year-old man, a former smoker, who had ALK-rearranged NSCLC. The second case focused on a 52-year-old man, a never-smoker, who had advanced ROS1-positive NSCLC.
For the first case, therapy with alectinib was started after diagnosis. In March, the patient reported asthenia and dry cough. Six days later, he developed ageusia, anosmia, and night sweats. The symptoms resolved about 1 month later, and a CT scan showed a partial response. The test for the virus was performed once the infection was in remission. For the second case, the patient received lorlatinib and achieved a complete response in January 2020. In March, the patient reported a dry cough and fever. A high-resolution CT scan showed the start of multiple bilateral ground-glass opacities with a paving pattern, suggestive of SARS-CoV-2; however, a negative result for the virus was later confirmed and treatment continued. Subsequently, a CT scan showed complete resolution of the interstitial pneumonia.
Both cases tested negative for SARS-CoV-2, but their symptoms, CT scans, and laboratory findings strongly resembled the virus. The severity of the virus was mild, and younger age and overall good performance status were two factors that influenced clinical decisions.
Disclosure: For full disclosures of the study authors, visit ejcancer.com.
