Case Study Raises Possibility Of Tocilizumab For COVID-19 Treatment In Cancer Patients

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: The interleukin (IL)-6 receptor inhibitor tocilizumab has been used by French clinicians to treat a patient with metastatic renal cell carcinoma (RCC) infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). 

In a letter to the Annals of Oncology, Jean-Marie Michot and co-workers, from Université Paris-Saclay in Villejuif, France, say that the patient with COVID-19 had a “rapid favorable outcome” after two intravenous infusions of tocilizumab, a drug usually given for rheumatoid arthritis. 

Noting that tocilizumab has been indicated for cytokine release syndrome associated with chimeric antigen receptor T-cell therapies, the team hypothesized that the agent might help combat the cytokine storm reported in COVID-19 patients who develop SARS. 

The 42-year-old patient with sarcomatoid clear cell RCC was admitted to hospital in March 2020 after developing a fever and bone metastasis pain that did not respond to outpatient ceftriaxone. On day 6 he developed mild cough and continued to have a fever; he tested positive for SARS-CoV-2 infection and chest computed tomography showed bilateral patchy ground glass opacities. 

The patient was treated with lopinavir–ritonavir for 5 days but on day 8 he required oxygen supplementation for sudden dyspnoea and saturation drop. 

Jean-Marie Michot and team say that the patient had “good tolerability” for two doses of tocilizumab 8 mg/kg given 8 hours apart. His temperature normalised and his oxygen requirements gradually reduced, allowing discontinuation on day 12. 

At this time, there was partial regression of pulmonary infiltrates, accompanied by a decrease in C-reactive protein from 225 mg/L to 33 mg/L over 4 days, which the clinicians say acts as a surrogate marker for a cytokine storm. 

They note that lopinavir–ritonavir therapy has subsequently been shown in a clinical trial to be ineffective for the treatment of COVID-19 and therefore it is “unlikely this changed the disease trajectory” for this patient. 

“It thus seems likely that the rapid control of the pulmonary hyperinflammation resulted from tocilizumab treatment”, the clinicians write, suggesting that this “promising therapy” be “studied urgently” for the treatment of COVID-19. 

However, the authors emphasize that this patient was immunosuppressed and showed a high level of senescence in his lymphocytic population, and “this case is therefore not generalizable to the non-cancer population.” 

Reference  

Michot J-M, Albiges L, Chaput N, et al. Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: a case report. Ann Oncol; Advance online publication 2 April 2020.
doi: 10.1016/j.annonc.2020.03.300