Cancer treatment ＆COVID-19　　　　In the COVID-19 era, importance of prescribing ACE2-lowering antineoplastics

Foote et al. reported that patients who received a potential ACE2-lowering antineoplastic exhibited a statistically significantly reduced SARS-CoV-2 positivity rate of 7.0% compared with 12.9% in patients who received other antineoplastic therapies. Potential ACE2-lowering antineoplastics, including mTOR/PI3K inhibitors and antimetabolites, may exhibit clinical anti–SARS-CoV-2 activity.

In the current COVID-19 era, the results of clinical studies reported by Foote et al. are very interesting and important.

Cancer treatment is performed by first-line treatment, second-line treatment, and third-line treatment according to clinical practice guidelines for each cancer type. Therefore, an appropriate antitumor agent is prescribed according to the progress of each cancer type and the patient's medical history. Until now, in clinical practice, antitumor agents for each cancer type have not been selected while considering ACE2-lowering antineoplastics.

Currently, personalized medicine by cancer genome test is performed in cancer treatment all over the world. In Japan as well, the Cancer Genome Panel Test (NCC oncopanel, FoundationOne CDx) was covered by health insurance on June 1, 2019. Therefore, in Japan, from the end of 2019, personalized medicine by cancer genome test has been performed.

From January 2020 to July 2021, personalized medical care by cancer genome testing is being performed for about 850 cancer patients at national university hospitals in Japan. ACE2-lowering antineoplastics including mTOR/PI3K inhibitors and antimetabolites (i.e., everolimus, temsirolimus, alpelisib, decitabine, gemcitabine, cabazitaxel, dasatinib, crizotinib) were recommended or suggested to 65 cancer patients.

From the results of clinical trials so far, it has been reported that the anti-SARS-CoV-2 antibody titer induced by second doses of COVID-19 mRNA vaccine is lower in cancer patients than in healthy subjects. In the future, when it is possible to select multiple antitumor drug prescriptions for cancer patients in clinical practice, it might be important to preferentially prescribe ACE2-lowering antineoplastics in consideration of anti-SARS-CoV-2.

Cancer medical doctor/Cancer genomic medicine/Emerging infectious diseases JAMA Oncology Published on May 10, 2021. by Kyoto@takuma H