COVID-19 Infection in a Patient on Immunotherapy for Lung Cancer Since 2013
Posted: Friday, April 17, 2020
Patients undergoing cancer treatment have an immunocompromised state, which can place them at high risk for severe COVID-19 infection. In a recent case study published in the Journal of Thoracic Oncology, Bonomi et al describe the case of a patient who was in partial remission with immunotherapy for metastatic lung cancer who died after COVID-19 infection.
“This case evidences the importance of [a] multidisciplinary approach, even in the presence of [a] severe outbreak like pandemic COVID-19, because the knowledge of underlying disease and concomitant treatments is important to take the best individual therapeutic decision,” concluded the study authors.
A 65-year-old patient was admitted to the Papa Giovanni XXIII Hospital emergency room with complaints of shortness of breath, disorientation, and fever. He had a history of emphysema and lung adenocarcinoma, which was treated with cerebral metastasectomy, panencefalic radiotherapy, and both carboplatin and pemetrexed chemotherapy. Persistent disease progression continued after six cycles of chemotherapy, at which time the patient received nivolumab starting in August 2013. As a result of treatment, the patient had a partial response, and the disease was considered to be stable.
Chest x-rays found reticular interstitial addensative findings, and an arterial blood gas test confirmed hypoxia. Laboratory results displayed normal leukocytes with lymphopenia, increased C-reactive protein, transaminases, and lactate dehydrogenase. Nasal swabs confirmed a positive diagnosis of COVID-19 infection.
The following day, the patient received empiric antibiotic treatment and oxygen therapy with a reservoir mask at 15 L/min. However, the patient was never administered lopinavir plus ritonavir and hydroxychloroquine because he needed to be sedated for agitation. The patient died 4 days later, after COVID-19 infection evolved into respiratory failure.
Disclosure: For study authors’ disclosures, visit www.jto.org.
