COVID-19 and lung cancer: risks, mechanisms and treatment interactions
COVID-19 and lung cancer: risks, mechanisms and treatment interactions
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DOI：
10.1136/jitc-2020-000892
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发表时间：
2020-05-01
影响因子：
10.9
通讯作者：
Friedlaender, Alex
中科院分区：
文献类型：
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作者：
Addeo, Alfredo;Obeid, Michel;Friedlaender, Alex
2019年新型冠状病毒也称为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的病例在全球范围内继续上升。迄今为止，还没有有效的治疗方法。临床管理主要是症状性的，重症监护中对重症患者进行器官支持。最近开始了测试疫苗效力的第一阶段试验，但与此同时，迫切需要降低严重病例的发病率和死亡率。众所周知，癌症患者比非癌症个体更容易感染，因为他们的全身免疫抑制状态由恶性肿瘤和抗癌治疗引起。因此，这些患者可能会增加COVID-19肺部并发症的风险。在某些情况下，SARS-CoV-2可诱导过度和异常的无效宿主免疫应答，这些免疫应答与潜在致命的严重肺损伤相关，患者可发展为急性呼吸窘迫综合征（ARDS）。细胞因子释放综合征和病毒性ARDS是由不受控制的严重急性炎症所致。急性肺损伤由肺腔上皮中的炎性单核细胞和巨噬细胞活化引起，其导致促炎细胞因子（包括白介素（IL）-6、IL-1和肿瘤坏死因子-α）的释放。这些细胞因子在免疫相关性肺炎中起着至关重要的作用，当浸润以T细胞为主或存在高IL-6相关炎症的间接迹象（如C反应蛋白升高）时，这些细胞因子可能是一个有希望的靶点。托珠单抗是一种单克隆抗IL-6受体抗体，已在中国和意大利的许多病例中使用。已报告了积极的临床和放射学结局。这些早期发现导致了在中国和意大利进行的随机对照临床试验。虽然人们热切期待这些试验的数据，但患者的管理将继续依赖于绝大多数当地指南。在许多其他方面，这场危机已经证明，不同的专家必须联合起来，为病人提供最好的护理。
Cases of the 2019 novel coronavirus also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to rise worldwide. To date, there is no effective treatment. Clinical management is largely symptomatic, with organ support in intensive care for critically ill patients. The first phase I trial to test the efficacy of a vaccine has recently begun, but in the meantime there is an urgent need to decrease the morbidity and mortality of severe cases. It is known that patients with cancer are more susceptible to infection than individuals without cancer because of their systemic immunosuppressive state caused by the malignancy and anticancer treatments. Therefore, these patients might be at increased risk of pulmonary complications from COVID-19. The SARS-CoV-2 could in some case induce excessive and aberrant non-effective host immune responses that are associated with potentially fatal severe lung injury and patients can develop acute respiratory distress syndrome (ARDS). Cytokine release syndrome and viral ARDS result from uncontrolled severe acute inflammation. Acute lung injury results from inflammatory monocyte and macrophage activation in the pulmonary luminal epithelium which lead to a release of proinflammatory cytokines including interleukin (IL)-6, IL-1 and tumor necrosis factor-alpha. These cytokines play a crucial role in immune-related pneumonitis, and could represent a promising target when the infiltration is T cell predominant or there are indirect signs of high IL-6-related inflammation, such as elevated C-reactive protein. A monoclonal anti-IL-6 receptor antibody, tocilizumab has been administered in a number of cases in China and Italy. Positive clinical and radiological outcomes have been reported. These early findings have led to an ongoing randomized controlled clinical trial in China and Italy. While data from those trials are eagerly awaited, patients' management will continue to rely for the vast majority on local guidelines. Among many other aspects, this crisis has proven that different specialists must join forces to deliver the best possible care to patients.