COVID-19 Research in the Cancer Clinic
In addition to lab-based research, scientists have explored repurposing drugs used in cancer treatment as potential therapies for COVID-19 patients. Richardson's work with defibrotide is one example. Another trial, headed by Steven Treon, MD, PhD,
is examining the use of ibrutinib, a drug used in treating blood cancers, to prevent lung injury in patients infected with the coronavirus.
Francisco Marty, MD, who was an infectious disease specialist at Dana-Farber, led trials at Brigham and Women's Hospital of the antiviral drug remdesivir, which is the only approved drug to treat COVID-19. A clinical trial of a "cocktail" of different monoclonal antibodies made by Regeneron to treat hospitalized patients with COVID-19 is underway.
Another clinical trial, known as PRE-VENT, is trying to determine if a drug, pacritinib, a JAK inhibitor used in treating myelofibrosis — a rare form of cancer — can prevent acute respiratory distress syndrome in patients with severe COVID-19 disease.
JAK inhibitors block a cell process known as JAK-STAT signaling, which produces cytokines — small proteins that activate immune and inflammation responses. JAK inhibitors can help reduce excess cytokine release, which can occur in patients with COVID-19
infections, causing damage to the lungs and other tissues. Richard Stone, MD, chief of staff and director of Translational Research in the Adult Leukemia Program, is leading the PRE-VENT trial.
Cancer Patients and Coronavirus Vaccines
Dana-Farber scientists are also focusing on a major concern at the Institute: the increased vulnerability of cancer patients to the coronavirus. Studies have shown cancer patients to be at significantly higher risk of infection and of developing severe
disease. One reason is that their immune systems are frequently weakened by the disease or the therapies used to treat it, leaving them more susceptible to infection.
However, there is still a lot to be learned about the interaction of COVID and cancer, and many questions are unanswered. Among them: which cancer patients are at highest risk of severe COVID-19 infection? How does immunotherapy or treatment that suppresses
the immune system influence susceptibility to the coronavirus? How do chemotherapies and targeted drug therapies influence vulnerability? Could cancer immunotherapies such as checkpoint inhibitor drugs help? When is it safe to resume cancer therapy
after infection? And how will cancer patients respond to the new coronavirus vaccines?
These are some of the issues being investigated in a study called RECOVOR led by Deborah Schrag, MD, MPH, chief of Population Sciences at Dana-Farber. A large team of investigators from multiple disciplines are collaborating on the study, which will compare matched pairs of patients with and without COVID. The goal is to understand what factors predispose some cancer patients to
COVID infection, particularly in its severe form, as well as which patients recover more easily from the disease. Schrag says there is some evidence for increased risk in patients with leukemia and lung cancer and for patients who are obese, but the
investigators hope to gather more information on risk factors among patients who have and haven't had the vaccine.
The RECOVOR study is being conducted in both children and adults Institute-wide and will serve as a shared resource that can be used by investigators. RECOVOR includes detailed interviews of patients who have had COVID and investigates the extent to which
COVID has affected cancer treatment and recovery.
Researchers will collect blood and saliva specimens at intervals six months apart. The samples will be analyzed for biochemical markers associated with better or worse responses to the virus. They will also search for antibodies that may have developed
in patients who recover from COVID-19 and look at how long the antibodies last.
A separate study, called IMPACT, is examining what effect COVID infections and vaccinations have on people with blood cancer precursor conditions. These precursor conditions, MGUS (monoclonal
gammopathy of undetermined significance) and smoldering myeloma, are estimated to affect about 12 million people, and usually don't cause symptoms, despite the presence of abnormal proteins in the blood. However, they have the potential to progress
to multiple myeloma, a blood cancer.
The study is led by Dana-Farber's Irene Ghobrial, MD, who founded the Center for Prevention of Progression of Blood Cancers,
where people with precursor conditions are monitored. Recent research has shown that the immune system is abnormal in people with MGUS and smoldering myeloma. The IMPACT study aims to determine how the immune system responds to COVID-19 infection
and the long-term impact of the virus in patients with these precursor conditions.