Mellinghoff, Sibylle C., Vanshylla, Kanika 
ORCID: 0000-0003-4552-9170, Dahlke, Christine, Addo, Marylyn M., Cornely, Oliver A., Klein, Florian, Persigehl, Thorsten, Rybniker, Jan, Gruell, Henning and Broeckelmann, Paul J.
(2021).
Case Report: Clinical Management of a Patient With Metastatic Non-Small Cell Lung Cancer Newly Receiving Immune Checkpoint Inhibition During Symptomatic COVID-19.
Front. Immunol., 12.
LAUSANNE:
FRONTIERS MEDIA SA.
ISSN 1664-3224
Abstract
Effects of initiation of programmed-death-protein 1 (PD1) blockade during active SARS-CoV-2 infection on antiviral immunity, COVID-19 course, and underlying malignancy are unclear. We report on the management of a male in his early 40s presenting with highly symptomatic metastatic lung cancer and active COVID-19 pneumonia. After treatment initiation with pembrolizumab, carboplatin, and pemetrexed, the respiratory situation initially worsened and high-dose corticosteroids were initiated due to suspected pneumonitis. After improvement and SARS-CoV-2 clearance, anti-cancer treatment was resumed without pembrolizumab. Immunological analyses with comparison to otherwise healthy SARS-CoV-2-infected ambulatory patients revealed a strong humoral immune response with higher levels of SARS-CoV-2-reactive IgG and neutralizing serum activity. Additionally, sustained increase of Tfh as well as activated CD4(+) and CD8(+) T cells was observed. Sequential CT scans showed regression of tumor lesions and marked improvement of the pulmonary situation, with no signs of pneumonitis after pembrolizumab re-challenge as maintenance. At the latest follow-up, the patient is ambulatory and in ongoing partial remission on pembrolizumab. In conclusion, anti-PD1 initiation during active COVID-19 pneumonia was feasible and cellular and humoral immune responses to SARS-CoV-2 appeared enhanced in our hospitalized patient. However, distinguishing COVID-19-associated changes from anti-PD1-associated immune-related pneumonitis posed a considerable clinical, radiographic, and immunologic challenge.
| Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||||||||||
| Creators: |
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| URN: | urn:nbn:de:hbz:38-595435 | ||||||||||||||||||||||||||||||||||||||||||||
| DOI: | 10.3389/fimmu.2021.798276 | ||||||||||||||||||||||||||||||||||||||||||||
| Journal or Publication Title: | Front. Immunol. | ||||||||||||||||||||||||||||||||||||||||||||
| Volume: | 12 | ||||||||||||||||||||||||||||||||||||||||||||
| Date: | 2021 | ||||||||||||||||||||||||||||||||||||||||||||
| Publisher: | FRONTIERS MEDIA SA | ||||||||||||||||||||||||||||||||||||||||||||
| Place of Publication: | LAUSANNE | ||||||||||||||||||||||||||||||||||||||||||||
| ISSN: | 1664-3224 | ||||||||||||||||||||||||||||||||||||||||||||
| Language: | English | ||||||||||||||||||||||||||||||||||||||||||||
| Faculty: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||
| Divisions: | Unspecified | ||||||||||||||||||||||||||||||||||||||||||||
| Subjects: | no entry | ||||||||||||||||||||||||||||||||||||||||||||
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| URI: | http://kups.ub.uni-koeln.de/id/eprint/59543 |
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