Unlike other comorbidities, metastatic lung adenocarcinoma did not escalate the progression of COVID-19 according to results from a case report published in the American Society of Clinical Oncology.
A 76-year-old man with metastatic lung adenocarcinoma and a history of chronic obstructive pulmonary disease tested positive for SARS-CoV-2 infection in Spain. He presented with fever, shortness of breath, and bibasal crackles 1 week after his 6th maintenance cycle of cisplatin-pemetrexed and pembrolizumab treatment for his cancer. A blood test showed lymphocytes 120/mL, neutrophils 430/mL, platelets 84,000/mL, C-reactive protein 24.4 mg/dL, and high D-dimer. A chest radiograph revealed diffuse infiltrate in his lungs.
The patient was isolated and prescribed piperacillin-tazobactam for his febrile neutropenia and given respiratory support. More aggressive treatments, such as hydroxychloroquine, lopinavir-ritonavir, and tocilizumab, were not prescribed due to his cytopenia. This case report was published while the patient remained positive for SARS-CoV-2 infection, but with a good disease evolution.
A limitation of this study was the small sample size and short study period; it remains unclear whether the patient recovered from his COVID-19 respiratory symptoms or if the disease evolution changed necessitating more aggressive treatments or mechanical ventilation.
The study authors concluded that patients with cancer have a similar COVID-19 disease progression as the general, symptomatic population. The investigators recommended early administration of empirical antibiotic treatments for 7 to 10 days, respiratory support, and strict patient surveillance. Further case studies are needed in order to better understand the relationship between cancers and the SARS-CoV-2 virus.
Figuero-Pérez L, Olivares-Hernández A, Escala-Cornejo RA, Cruz-Hernández JJ. Management of febrile neutropenia associated with SARS-CoV-2 infection in a patient with cancer [published online May 5, 2020]. JCO Oncol Pract. doi:10.1200/OP.20.00197