# SARS-CoV-2 Infection Alters the Immune Microenvironment in Lung Cancer Patients Undergoing Immunotherapy and Affects Treatment Outcomes

## TL;DR

This study shows that SARS-CoV-2 infection changes immune responses in lung cancer patients on immunotherapy but does not harm treatment outcomes and may even offer short-term benefits.

## Contribution

The study reveals that SARS-CoV-2 infection alters immune cell and cytokine profiles in lung cancer patients without reducing immunotherapy effectiveness.

## Key findings

- SARS-CoV-2 infection caused prolonged elevated IL-10 and IL-12p70 levels and reduced monocyte proportions for up to 10 weeks.
- Infected patients showed a transient improvement in disease control despite immune perturbation.
- Sustained IL-10 and IL-12p70 levels in non-infected patients correlated with longer progression-free survival.

## Abstract

Background: The COVID-19 pandemic prompted investigation into the interaction between SARS-CoV-2 infection and immune checkpoint inhibitor (ICI) therapy in lung cancer patients. Understanding this interplay is crucial for optimizing cancer immunotherapy. Methods: A retrospective analysis was conducted on lung cancer patients, characterizing changes in peripheral immune cells and plasma cytokines (including IL-10 and IL-12p70) before, during, and after SARS-CoV-2 infection. Progression-free survival (PFS) was compared between ICI-treated patients with and without COVID-19. Cytokine dynamics were further analyzed in a non-infected cohort. Results: SARS-CoV-2 infection induced a prolonged systemic cytokine storm, with elevated IL-10 and IL-12p70 levels and reduced monocyte proportions lasting up to 10 weeks post-recovery. Despite this immune perturbation, COVID-19 did not impair long-term PFS; instead, a transient improvement in disease control was observed in infected patients. In non-infected patients, sustained or increased IL-10 and IL-12p70 levels during ICI therapy were associated with longer PFS (p < 0.05). Conclusions: SARS-CoV-2 infection transiently alters the immune landscape in lung cancer patients without compromising ICI efficacy. The sustained elevation of IL-10 and IL-12p70 may contribute to short-term clinical benefits. Monitoring cytokine dynamics could serve as a prognostic tool for predicting ICI response.