COVID-19 and Lung Cancer: Focus on ALK/ROS1 Inhibitors
Posted: Monday, July 20, 2020
A pair of case studies published as a Letter to the Editor in the European Journal of Cancer focused on two patients with advanced oncogene-driven non–small cell lung cancer (NSCLC) who developed presumptive COVID-19 while undergoing treatment with ALK/ROS1 tyrosine kinase inhibitors (TKI). Alessandro Leonetti, MD, of the University Hospital of Parma, Italy, and colleagues reported that both patients recovered from SARS-CoV-2 interstitial pneumonia without undergoing antiviral treatments.
A 62-year-old man was diagnosed with ALK-rearranged NSCLC in January 2020, with bilateral lung metastases. The patient began alectinib therapy on January 31 and presented with COVID-19 symptoms of dry cough and asthenia on March 16, which were treated with a daily inhaler. On March 22, symptoms progressed to include ageusia, anosmia, and night sweats, although the cough improved. By March 29, COVID-19 symptoms resolved. A CT scan revealed partial disease response, and the patient was discharged on continued alectinib treatment. By April 4, he tested negative for COVID-19.
A 52-year-old man was diagnosed with advanced ROS1-positive NSCLC in September 2015. The patient began lorlatinib treatment in November 2019, after disease progression to the brain while on crizotinib treatment. On March 9, 2020, the patient presented with fever and a progressive, dry cough. Multiple bilateral ground-glass opacities were identified, although a COVID-19 test was negative. The patient underwent 10 days of antibiotic treatment while continuing to receive lorlatinib. By March 18, respiratory symptoms were improved, and supplemental oxygen was no longer needed. A CT scan on April 9 confirmed resolution of interstitial pneumonia.
“Even though the COVID-19 outcome in our patients who continued TKIs was favorable, we could not draw definitive conclusions. Large-scale studies are urgently needed to assess whether or not TKIs should be maintained during SARS-CoV-2 pneumonia, especially when not severe, in order to avoid potentially dangerous withdrawal of effective anticancer drugs,” noted the investigators.
Disclosure: For full disclosures of the study authors, visit ejcancer.com.