The pandemic caused by the novel coronavirus SARS-CoV-2 has placed an unprecedented burden on healthcare systems around the world. In patients who experience severe disease, acute respiratory distress is often accompanied by a pathological immune reaction, sometimes referred to as 'cytokine storm'. One hallmark feature of the profound inflammatory state seen in patients with COVID-19 who succumb to pneumonia and hypoxia is marked elevation of serum cytokines, especially interferon gamma, tumor necrosis factor alpha, interleukin 17 (IL-17), interleukin 8 (IL-8) and interleukin 6 (IL-6). Initial experience from the outbreaks in Italy, China and the USA has anecdotally demonstrated improved outcomes for critically ill patients with COVID-19 with the administration of cytokine-modulatory therapies, especially anti-IL-6 agents. Although ongoing trials are investigating anti-IL-6 therapies, access to these therapies is a concern, especially as the numbers of cases worldwide continue to climb. An immunology-informed approach may help identify alternative agents to modulate the pathological inflammation seen in patients with COVID-19. Drawing on extensive experience administering these and other immune-modulating therapies, the Society for Immunotherapy of Cancer offers this perspective on potential alternatives to anti-IL-6 that may also warrant consideration for management of the systemic inflammatory response and pulmonary compromise that can be seen in patients with severe COVID-19.
Journal for immunotherapy of cancer. 2020 May [Epub]
Fernanda I Arnaldez, Steven J O'Day, Charles G Drake, Bernard A Fox, Bingqing Fu, Walter J Urba, Vincenzo Montesarchio, Jeffrey S Weber, Haiming Wei, Jon M Wigginton, Paolo Antonio Ascierto
MacroGenics Inc, Rockville, Maryland, USA., John Wayne Cancer Institute and Cancer Clinic, Providence Saint John's Health Center, Santa Monica, California, United States., Herbert Irving Cancer Center, Columbia University Medical Center, New York, New York, USA., Earle A Chiles Research Institute, Portland, Oregon, USA., University of Science and Technology of China, Hefei, Anhui, China., A.O.R.N. dei Colli Monaldi-Cotugno-CTO Hospitals, Naples, Italy., Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA., Frederick, Maryland, USA., Istituto Nazionale Tumori IRCCS Fondazione 'G. Pascale', Napels, Italy .