Immunotherapy during COVID-19 pandemic: An experience at a tertiary care center in India

Introduction: COVID-19 pandemic has been a curse for cancer patients. The lack of understanding and unawareness in handling cancer patients during this pandemic has worsened their conditions. To analyze the real-world scenario, we studied 13 patients who were given immunotherapy during this COVID pandemic era and tried to analyze their outcome or any serious adverse effect that they suffered. This was a pilot study which would pave the way for further bigger studies in future. The aim of the study was to collect the details of patient receiving immunotherapy during COVID-19 pandemic. The data collected included the diagnosis, certain investigations, and the effects of the immunotherapy drugs and its side effects. Results: During this COVID pandemic period starting from March 20 to June 20, we have been regularly giving immunotherapy drugs such as nivolumab, pembrolizumab, and atezolizumab to our patients. We had given six patients nivolumab, six patients pembrolizumab, and one patient atezolizumab. Of the 13 patients who continued to receive immunotherapy in COVID pandemic era, 4 patients were receiving immunotherapy for lung cancer, 3 for head-and-neck malignancy, 2 for relapse lymphoma, and 1 each for hepatocellular carcinoma, renal cell cancer, malignant melanoma, and soft-tissue cancer. One of the patients receiving atezolizumab had actually progressed after receiving pembrolizumab. There was no Grade 3 or 4 toxicity to these drugs and most of our patients continued to be in stable disease/partial remission. One patient had died just after receiving one cycle of nivolumab. Conclusion: COVID-19 infection has posed an unforeseen predicament both for the patients and the treating oncologist. In absence of any previous data, it is very difficult to manage cancer patients where the treatment itself is thought to harm the patients. This is a humble effort to bring to the notice of the world that immunotherapy can be continued during COVID pandemic, provided we take all due precautions.