How Cancer Type Can Affect COVID-19 Risk

Substantial evidence indicates that patients with cancer who contract coronavirus disease 2019 (COVID-19) face higher risks of severe disease; however, a new report suggests the risk of contracting the virus may vary depending on the type of cancer a patient has.

In a letter to the editor of the Journal of Infection, corresponding author Shan Zeng, MD, PhD, of Central South University, in China, and colleagues offer what they believe to be the first evaluation of COVID-19 risk for patients with cancer using a pan-cancer analysis of the expression levels of angiotensin-converting enzyme-2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), which are receptors through which SARS-CoV-2 enters the body.

In explaining their analysis, Zeng and colleagues noted that the 2 receptors at play are located mainly in the respiratory tract, lung, and intestines. However, they added that the receptors are also expressed by many tumor cells.

The evaluation showed esophageal carcinoma (ESCA), kidney renal papillary cell carcinoma (KIRP), lung adenocarcinoma (LUAD), and uterine corpus endometrial carcinoma (UCEC) high high expression levels of ACE2.

Meanwhile, kidney chromophobe (KICH), prostate adenocarcinoma (PRAD), and UCEC had high levels of TMPRSS2 expression. The results suggest patients with these types of cancers face a higher risk of COVID-19 infection.

“We also found that only UCEC is co-expressing ACE2 and TMPRSS2 receptors; therefore, patients with UCEC carry the highest risk of COVID-19 infection,” investigators wrote.

Not only is the risk of infection higher, but the investigators noted it will be more difficult to clear the virus if it infects the tumor cells due to the inherent immune resistance of the tumor.

If a patient has difficulty clearing the virus, the longer duration of the illness will increase the chance or organ and tissue damage, and even if tissues are not invaded by the virus directly, Zeng and colleagues wrote that inflammatory reactions like cytokine storms could cause damage and also promote the progression of tumors.

As with much of the literature surrounding COVID-19, investigators explained that treatment for these patients is still evolving, and mainly consists of supportive care. Some clinicians have suggested using ACE inhibitors or angiotensin receptor blocker (ARB). However, Zeng and colleagues noted that mortality rates for patients with hypertension have not been shown to improve with the therapies.

Bruton kinase (BTK) inhibitors could be a good choice for patients with lymphoma, since they can reduce the body’s inflammatory reaction. Cytokine inhibitors might also be helpful, they wrote, since cytokines can promote tumor progression.

The investigators closed by reiterating that while there are no established guidelines for treating patients with cancer and COVID-19, physicians ought to think about how to treat both the infection and the tumors themselves. One way to evaluate those options is to consider the type of cancer a patient has in light of the new analysis.

“Most importantly, close attention should be paid to patients with UCEC in determining whether they are cured of COVID-19,” Zeng and colleagues concluded. “And to this effect, we suggest the use of a nucleic acid test of curettage specimens from the endometrium in addition to the nasal swab test.”