Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale di Tumori, Milan, Italy.
Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), Los Angeles, California.
Cancer Immunol Res. 2021 Mar;9(3):261-264. doi: 10.1158/2326-6066.CIR-21-0008. Epub 2021 Jan 15.
The immunomodulatory effects of immune-checkpoint blockade (ICB) therapy for cancer may act at the crossroads between the need to increase antiviral immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to decrease the inflammatory responses in severe cases of coronavirus disease 2019 (COVID-19). There is evidence from preclinical models that blocking programmed death receptor 1 (PD1) protects against RNA virus infections, which suggests that patients with cancer receiving ICB may have lower rates of viral infection. However, given the heterogeneity of patient characteristics, this would be difficult to demonstrate using population-based registries or in clinical trials. Most studies of the impact of ICB therapy on the course of COVID-19 have centered on studying its potential detrimental impact on the course of the COVID-19 infection, in particular on the development of the most severe inflammatory complications. This is a logical concern as it is becoming clear that complications of COVID-19 such as severe respiratory distress syndrome are related to interferon signaling, which is the pathway that leads to expression of the PD1 ligand PD-L1. Therefore, PD1/PD-L1 ICB could potentially increase inflammatory processes, worsening the disease course for patients. However, review of the current evidence does not support the notion that ICB therapy worsens complications from COVID-19, and we conclude that it supports the continued use of ICB therapy during the COVID-19 pandemic provided that we now collect data on the effects of such therapy on COVID-19 vaccination.
免疫检查点阻断 (ICB) 疗法对癌症的免疫调节作用可能作用于需要增加对严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的抗病毒免疫反应和降低 2019 年冠状病毒病 (COVID-19) 严重病例中炎症反应的交叉点。临床前模型的证据表明，阻断程序性死亡受体 1 (PD1) 可预防 RNA 病毒感染，这表明接受 ICB 的癌症患者的病毒感染率可能较低。然而，鉴于患者特征的异质性，使用基于人群的登记处或临床试验很难证明这一点。大多数关于 ICB 治疗对 COVID-19 病程影响的研究都集中在研究其对 COVID-19 感染病程的潜在不利影响上，特别是对最严重炎症并发症的影响。这是一个合乎逻辑的关注点，因为越来越明显的是，COVID-19 的并发症，如严重呼吸窘迫综合征，与干扰素信号有关，而干扰素信号是导致 PD1 配体 PD-L1 表达的途径。因此，PD1/PD-L1 ICB 可能会潜在地增加炎症过程，使患者的疾病进程恶化。然而，对当前证据的回顾并不支持 ICB 治疗会使 COVID-19 的并发症恶化的观点，我们得出的结论是，在 COVID-19 大流行期间，继续使用 ICB 治疗是合理的，前提是我们现在收集关于此类治疗对 COVID-19 疫苗接种影响的数据。
