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Review
. 2020 May 8;22(5):53.
doi: 10.1007/s11912-020-00934-7.

COVID-19 and Cancer: A Comprehensive Review

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Free PMC article
Review

COVID-19 and Cancer: A Comprehensive Review

Rohit Gosain et al. Curr Oncol Rep. .
Free PMC article

Abstract

Purpose of review: The outbreak of the novel coronavirus disease 2019 (COVID-19) has emerged to be the biggest global health threat worldwide, which has now infected over 1.7 million people and claimed more than 100,000 lives around the world. Under these unprecedented circumstances, there are no well-established guidelines for cancer patients.

Recent findings: The risk for serious disease and death in COVID-19 cases increases with advancing age and presence of comorbid health conditions. Since the emergence of the first case in Wuhan, China, in December 2019, tremendous research efforts have been underway to understand the mechanisms of infectivity and transmissibility of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a fatal virus responsible for abysmal survival outcomes. To minimize the mortality rate, it becomes prudent to identify symptoms promptly and employ treatments appropriately. Even though no cure has been established, multiple clinical trials are underway to determine the most optimal strategy. Managing cancer patients under these circumstances is rather challenging, given their vulnerable status and the aggressive nature of their underlying disease. In this comprehensive review, we discuss the impact of COVID-19 on health and the immune system of those affected, reviewing the latest treatment approaches and ongoing clinical trials. Additionally, we discuss challenges faced while treating cancer patients and propose potential approaches to manage this vulnerable population during this pandemic.

Keywords: ACE2; ARDS; COVID-19; Cancer; Coronavirus; Immune response; Pandemic; Pneumonia; SARS; SARS-CoV-2.

Conflict of interest statement

Igor Puzanov has received compensation from Amgen for service as a consultant.

Rohit Gosain, Yara Abdou, Abhay Singh, Navpreet Rana, and Marc S. Ernstoff declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Entry mechanism of SARS-CoV-2 into host cell and subsequent inflammatory and immune cascade. SARS-CoV-2 gains entry into host cell when receptor-binding domain (RBD) of viral spike protein binds with host ACE2 receptors. Mucosal associated invariant T (MAIT) cells and γδ T cells respond to invasion releasing inflammatory cytokines. Early responding immune effector cells, including CTL and NK cells, are activated against virus. If persistent cytokine release continues, significant lung damage can occur (“cytokine storm”). Specific cytokine inhibitors, e.g., IL-6 inhibitors, help reduce lung damage. Protracted disease course can result in immune exhaustion (exhausted T cells) and anti-programmed death-1 (PD-1) inhibitors can help reinvigorate immune system. ALC, absolute lymphocyte count; CTL, cytotoxic T lymphocytes; IFN, interferon; IL-6, interleukin-6; NK, natural killer; PD, programmed death-1. * Created with BioRender
Fig. 2
Fig. 2
Case-fatality rate by age group in general population diagnosed with COVID-19 in China [15] along with probable roles of factors: age, ACE2 expression, immune profile, and comorbidities. ACE2, angiotensin-converting enzyme-2; yrs, years
Fig. 3
Fig. 3
Framework for prioritizing clinical management of cancer patients in COVID-19 pandemic. The prioritization-based management is adapted from the Ontario Health Cancer Care Ontario, where the patient with the lowest priority (priority C) could wait for further management until the pandemic resolves, while higher priority (specifically priority A) warrants immediate management as the benefits of the management outweigh the risks from the pandemic. Patients falling in priority B can often be slightly delayed, but usually a thorough discussion among the physician and patient further determines the course. Surg, surgery; Rad onc, radiation oncology; SBO, small bowel obstruction; SVC, superior vena cava syndrome; GI, gastrointestinal; RT, radiation therapy; CRT, chemoradiation therapy; I/O, immunotherapy

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