AUTHOR=Mellinghoff Sibylle C. , Vanshylla Kanika , Dahlke Christine , Addo Marylyn M. , Cornely Oliver A. , Klein Florian , Persigehl Thorsten , Rybniker Jan , Gruell Henning , Bröckelmann Paul J. 

TITLE=Case Report: Clinical Management of a Patient With Metastatic Non-Small Cell Lung Cancer Newly Receiving Immune Checkpoint Inhibition During Symptomatic COVID-19

JOURNAL=Frontiers in Immunology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.798276

DOI=10.3389/fimmu.2021.798276

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. Herein 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 with pembrolizumab, carboplatin and pemetrexed was initiated, 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 initially resumed without pembrolizumab. Immunological analyses with comparison to otherwise healthy SARS-CoV-2 infected 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 regres-sion 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 im-mune responses to SARS-CoV-2 appeared enhanced, however, distinguishing COVID-19-associated changes from anti-PD1-associated immune-related pneumonitis posed a consid-erable clinical and radiographic challenge.