In the month ending April 7, 423 cancer patients at Memorial Sloan Kettering Cancer Center were diagnosed with COVID-19, 20% of whom developed severe respiratory symptoms. That in itself was not surprising, given that cancer patients are immunocompromised and therefore face an increased risk of fighting the virus.
But a trend that emerged among COVID victims surprised their MSK oncologists: The risk of poor outcomes was higher among patients who had been treated with medications that inhibit “checkpoints” like PD-1 and CTLA-4 to that the immune system can recognize and attack cancer, according to a study (PDF) published in Nature Medicine.
The checkpoint inhibitors that patients received were Keytruda from Merck; Genentech Tecentriq; Opdivo and Yervoy of Bristol Myers Squibb; Imtrazi from AstraZeneca; and Bavencio from Merck KGaA and Pfizer. There were 31 patients in the study who were prescribed one or more of the checkpoint inhibitors.
The authors noted that the risk of poor COVID outcomes among patients with checkpoint inhibitors was not associated with age, type of cancer, or other diseases. “Although we observed more serious COVID-19 in [checkpoint inhibitor] recipients with underlying lung cancer, patients with non-lung cancer who were treated with [the drugs] it also showed severe results, “they wrote.
BMS told FiercePharma in an email that research to date shows that cancer patients diagnosed with COVID-19 have a higher death rate, but that the link between cancer therapies and virus results has not yet been established. is well understood. “More studies with longer follow-up are needed to better understand how COVID-19 affects cancer patients and, more specifically, whether different cancer treatments can have an impact on outcomes,” said Nick Botwood, vice president of clinical development of oncology. “We look forward to gathering and reviewing additional information that can help inform treatment decisions for physicians and patients.”
The other manufacturers of checkpoint inhibitors mentioned in the study did not provide comment at the time of publication.
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In the Nature Medicine article, the MSK authors said other studies had not discovered a link between cancer immunotherapy and COVID’s poor results. But those studies looked primarily at the outcome of death, while MSK researchers focused on the need for patients with the virus to receive supplemental oxygen, a much more common occurrence.
Still, when it comes to checkpoint inhibitors, “these findings should not affect whether patients receive treatment. Everyone who needs these drugs should get them, “study co-author Mini Kamboj, MSK’s chief medical epidemiologist, said in a blog post.” It is important that doctors are more vigilant about testing and monitoring the virus and that people with cancer take extra precautions to avoid infection. “
Some manufacturers of immuno-oncology drugs have been preparing for a pandemic recession, including Merck. During the company’s first-quarter earnings announcement, Merck executives said they expected to see a $ 2.1 billion drop in sales, mainly because two-thirds of its human health products must be managed by doctors, a challenge given the demand for social distancing. Keytruda, which is an infusion, is expected to take a hit.
Pfizer said in its quarterly call that its sales representatives were hampered by a lack of access to doctors, which is causing a slowdown in new prescriptions. CEO Albert Bourla predicted that the company would recoup lost revenue after the pandemic subsides. Meanwhile, both Pfizer and Merck are struggling to develop COVID-19 vaccines.
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BMS also warned of a slowdown due to COVID-19, although Opdivo’s sales were under pressure before the virus attack. The company celebrated some good news in May, when the FDA approved a combination of Opdivo and Yervoy for the first-line treatment of patients with metastatic non-small cell lung cancer. The duo was approved shortly thereafter in combination with two cycles of chemotherapy.
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