In the month ending April 7, 423 cancer patients at Memorial Sloan Kettering Cancer Center were diagnosed with COVID-19, 20% of whom developed serious respiratory symptoms. That in and of itself wasn’t surprising, given that cancer patients are immuno-compromised and therefore face a higher risk of struggling with the virus.
But one trend that emerged among those COVID victims did surprise their MSK oncologists: The risk of poor outcomes was higher among patients who had been treated with drugs that inhibit “checkpoints” such as PD-1 and CTLA-4 so the immune system can recognize and attack cancer, according to a study (PDF) published in Nature Medicine.
The checkpoint inhibitors that the patients received were Merck’s Keytruda; Genentech’s Tecentriq; Opdivo and Yervoy from Bristol Myers Squibb; AstraZeneca’s Imfinzi; 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 risk of poor COVID outcomes among patients on checkpoint inhibitors was not associated with age, cancer type or other illnesses, the authors noted. “Although we observed more severe COVID-19 in [checkpoint inhibitor] recipients with underlying lung cancer, patients with non-lung cancer who were treated with [the drugs] also demonstrated severe outcomes,” they wrote.
BMS told FiercePharma in an email that research to date shows that cancer patients diagnosed with COVID-19 have an increased mortality rate, but that the link between anticancer therapies and virus outcomes is still not well understood. "More studies with longer follow-up are needed to better understand how COVID-19 affects patients with cancer and, more specifically, whether different cancer treatments may have an impact on outcomes," Nick Botwood, VP of oncology clinical development, said. "We look forward to gathering and reviewing additional insights that may help inform treatment decisions for physicians and patients."
The other makers of checkpoint inhibitors named in the study did not provide comments by press time.
In the Nature Medicine paper, the MSK authors said that other studies had not uncovered a link between cancer immunotherapy and poor COVID outcomes. But those studies were looking primarily at the outcome of death, whereas the MSK researchers focused on the need for patients with the virus to receive supplemental oxygen—a far more common occurrence.
Still, when it comes to checkpoint inhibitors, “these findings should not affect whether patients get treated. Everyone who needs these drugs should still receive them,” study co-author Mini Kamboj, MSK’s chief medical epidemiologist, said in a blog post. “It’s just important for doctors to be extra vigilant about testing and monitoring for the virus and for people with cancer to take extra precautions to avoid infection.”
Some makers of immuno-oncology drugs have been bracing for a pandemic downturn, including Merck. During the company's first-quarter earnings announcement, Merck executives said they expected to see a $2.1 billion drop in sales, primarily because two-thirds of its human health products have to be administered by physicians—a challenge given demands for social distancing. Keytruda, which is an infusion, is expected to take a hit.
Pfizer said in its quarterly call that its sales reps were hamstrung by a lack of access to physicians, which is causing a slowdown in new prescriptions. CEO Albert Bourla predicted the company would recoup the lost revenues after the pandemic eases. Meanwhile, both Pfizer and Merck are hustling to develop vaccines against COVID-19.
BMS also warned of a slowdown due to COVID-19, although Opdivo sales were under pressure before the virus hit. The company did celebrate 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.