BTK Inhibitors in Cancer Patients with COVID-19: “The Winner Will be the One Who Controls That Chaos” (Napoleon Bonaparte)
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
In the setting of the COVID-19 pandemic, providers must consider how to optimally manage patients with hematologic malignancies. There is rationale both for and against continuation of BTK inhibitors in patients receiving these drugs for management of CLL and B cell lymphomas. Herein, we describe both benefits and risks of BTK inhibitor continuation. In favor of BTKi continuation, BTK plays an active role in macrophage polarization. By modulating key transcription factors, BTK may regulate macrophage polarization downstream of classic M1 and M2 polarizing stimuli and mitigate the hyperinflammatory state associated with COVID-19. In favor of BTKi discontinuation, we note a potentially increased risk of secondary infections and impaired humoral immunity. We hypothesize that the potential benefit of blunting a hyperinflammatory response to SARS-CoV-2 through attenuation of M1 polarization outweighs the potential risk of impaired humoral immunity, not to mention the risk of rapid progression of B-cell malignancy following BTKi interruption. On the basis of this, we suggest continuing BTKi in patients with COVID-19.
Clinical Cancer Research , résumé, 2019