How COVID-19 has Changed an Immuno-oncologist's Life: from Optimizing Daily Practice to the Targeted Treatment of Cytokine Storm

The spread of severe acute respiratory syndrome coronavirus 2 (SARS CoV2), changed the daily life of medical oncologists. To keep safe both patients and healthy workers is the most important rule. In our daily practice we adopted a specific policy about the conduct of our clinical managements of melanoma patients, in order to minimise the risk of any potential exposure. In addition, immuno-oncologists may have an important role during such pandemic. Indeed, they have an important experience in the management of immuno-related adverse events due to the hyperactivation of immune system as consequence of immunotherapy. Since the acute respiratory distress syndrome by COVID-19 seems to occur from an excess of cytokine production, some drugs used in the management of immune-related side effects could be useful for treating ARDS by COVID-19. In particular, they know the key role played by IL-6 in the pathogenesis of these kind of hyperinflammation syndromes. In Italy we started on 19th of March a phase II study (NCT04317092), which enrolled 330 patients in 24 hours, looking to the ability of tocilizumab to reduce the one-month mortality rate as main study endpoint. Results should be reported very soon. Other drugs active in reducing the cytokine release syndrome are at moment in clinical trial or expanded access program like JAK inhibitors, complement inhibitors, toll like receptor inhibitors and others.