medwireNews: The interleukin (IL)-6 receptor inhibitor tocilizumab warrants further investigation for the treatment of COVID-19 in patients with cancer, say the authors of a case report.
They highlight that the patient had “a rapid favorable outcome” and showed “good tolerability” to two infusions of tocilizumab, which is primarily indicated for rheumatoid arthritis, although it has recently been approved for cytokine release syndromes induced by chimeric antigen receptor T-cell therapies.
The team explains that the pathogenesis of COVID-19 – the disease associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) – “involves a cytokine storm” in which the pro-inflammatory cytokine IL-6 is proposed to have a major role, indicating that “IL-6 may be a potential actionable target cytokine to treat Covid-19-related acute respiratory distress syndrome.”
Jean-Marie Michot and fellow clinicians from Université Paris-Saclay in Villejuif, France, describe the case of a 42-year-old man with metastatic, sarcomatoid, clear-cell renal cell carcinoma who developed COVID-19.
The patient was admitted to the hospital for fever and symptomatic bone metastases pain that was unresponsive to ceftriaxone administered in the outpatient setting. He subsequently developed a mild cough, which prompted laboratory testing for SARS-CoV-2 with a positive result. And a chest computed tomography (CT) scan showed the presence of bilateral ground glass opacities signifying COVID-19.
Treatment with the combination antiviral therapy lopinavir–ritonavir was initiated and continued for 5 days, but the patient experienced sudden dyspnea and saturation drop on day 8, which required oxygen supplementation without artificial ventilation.
At this stage, he was given two doses of intravenous tocilizumab 8 mg/kg, at an interval of 8 hours, after which the patient started to show clinical improvement; his temperature normalized and the oxygen supplementation was decreased and finally discontinued on day 12.
The improvement was confirmed in a chest CT that showed “partial regression of the pulmonary infiltrates and ground glass appearance,” while levels of C-reactive protein, “a surrogate marker” for a cytokine storm, reduced from 225 to 33 mg/L over a 4-day period, reports the team.
Michot et al believe that concomitant treatment with lopinavir–ritonavir is unlikely to have changed the disease course since the combination “has recently been shown not to be effective in patients with severe Covid-19 in a randomized controlled trial.”
“It thus seems likely that the rapid control of the pulmonary hyperinflammation resulted from tocilizumab treatment,” they write in the Annals of Oncology.
The clinicians caution, however, that the findings are “not generalizable to the non-cancer population” as the patient was immunosuppressed due to cancer, but urge that this “promising therapy” should be “studied urgently” in people developing COVID-19.
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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Ann Oncol 2020; doi:10.1016/j.annonc.2020.03.300