Can Cancer Drugs Help Fight COVID-19?

Welcome, everyone. I'm Dr. John Whyte, chief medical officer at WebMD, and you're watching Coronavirus in Context. We talk about the importance of vaccination. But we also have to talk about the importance of therapeutics. How do we treat COVID? What's the role of cancer drugs? There's been some interesting research lately.

First, we are thinking it might harm people with COVID. Now we think it might be effective. So to help unpack all of this, I'm joined by Dr. Michael Foote he is a oncology fellow at Memorial Sloan Kettering. Dr. Foote, thanks for taking the time today.

Oh, thank you so much for inviting me to talk. And I'm hopeful that I can provide some assistance.

Well, let's start off. You published some research about certain types of cancer drugs and whether or not they could be effective against the Coronavirus. Can you summarize for our viewers what you found?

Absolutely. So I think there are a few important takeaways from our research study. The first is that as you alluded to before, many oncologists were concerned about the risk of severe COVID events, meaning our patients who get chemotherapy-- will they have a higher risk of needing to go to the hospital if they can track Coronavirus, would there be a higher risk of having a problem with their lungs or potentially even have a higher risk of mortality from COVID-19 if patients are being treated with chemotherapy?

So I think one of the important points of our study is that not all chemotherapy is the same. And in fact, some types of chemotherapy in our cohort actually seem to offer a benefit against Coronavirus infection.

What were some of those agents, and how did they work?

DR. MICHAEL FOOTE: So Coronavirus attaches to the surface of a cell in your body using a receptor which is almost like an antennae that the virus uses to grab on and attach itself and then infect the cell. So what we did is we looked at different drugs in a computer database that had activity at lowering this special antenna, this special receptor on the surface of the cell, called ACE-2.

And what we found is that when we looked at a large data set of patients at Memorial Sloan Kettering who were treated with different cancer drugs, people who are treated with certain cancer drugs had lower risks of COVID infection. And in fact, those drugs that were associated with a lower risk of COVID-19 infection were ones that seemed to be predicted to lower the ACE-2 receptor. So these were drugs that were mostly actually pills that patients take-- their oral chemotherapy agents. And they lower the activity of certain proteins inside of cancer cells, but they have activity on normal cells too. And so our thought process was that maybe some of these pathways that are implicated in cancer are actually the exact same signaling pathways that the Coronavirus might use to replicate itself.

Now there was discussion around that early on because some of these receptors, which are primarily on the lungs, are also used in blood pressure control. So we also don't want to confuse people that are listening. We do know that patients who are on ACE inhibitors or ARBs should continue to take those medications. We do not believe they're at greater risk. That's not what you're referring to here-- correct-- in terms of the populations that you studied.

Absolutely. And you bring up an excellent point. We had hypothesized that the ACE-2 receptor might mediate this benefit that-- for example, one of the drugs we used might lower the ACE-2 receptor and that might improve the ability of the body to withstand a Coronavirus infection. But to tell you the truth, probably what we stumbled on are other underlying mechanisms that we haven't really well characterized yet that these drugs work well on.

So for example, one of the drugs is inhibits a protein called BCR-ABL. And it's a protein that is heavily involved in cancer. But it may also act as a relative growth stimulating protein, something that maybe the virus uses to replicate itself or help itself spread in the body. So this inhibitor might help block Coronavirus from infecting the cell and successfully replicating itself. And we think a lot of these inhibitors that we found in our study are actually more general growth suppressants which makes sense if you think about it because cancer is a disease where cells grow and turn into tumors. And the virus hijacks some of those signaling mechanisms to serve itself and grow and replicate.

So I think a lot of the mechanisms behind our drugs, we haven't quite figured out yet. I totally agree though-- folks who are taking the ACE inhibitors should stay on them. There's a lot we don't know about the agents that we found that we're hoping to characterize further.

But what has surprised you? Because here you are, an oncologist, someone who treats cancer. COVID is primarily a respiratory virus, an infectious disease. But we're also learning it impacts other areas of our body. Are you kind of surprised that here, you're talking about COVID where normally you're talking about different types of cancer? What surprised you?

Yeah. It's such an astute point. Cancer in itself, especially when you're a medical oncologist, you do treat the whole body. Cancer is a disease that can spread to different organs in your body outside of where it originated. And so I think what you saw in the first stages of the pandemic was a lot of scientists who are used to treating cancer looking with those same perspectives at viruses. And what we found was incredible. We found that a lot of these mechanisms for growth, for infection, we're all connected together.

And it makes sense. It's almost like understanding the very basic biology of life. And I think, for me, the surprising part was just how well our disciplines superimposed each other between infectious disease and oncology. And so for me, I think the most surprising thing is just how neatly together and how beautifully together biology and infection and cancer medicine can fit together.

Where do you think the research goes from here based on your findings?

Well, I think based on our specific findings, there are particular cancer signaling pathways. But I think scientists in the lab can look at to see if maybe new Coronavirus drugs can be developed to target those pathways. Maybe those are important mechanisms that the Coronavirus uses to replicate itself that we didn't know about before this study. [LAUGHS]

I think the second and maybe even more intuitive concept is that oncologists can maybe feel a little bit more comfortable keeping their patients on certain cancer drugs because at the very least, we have a good sense that there are certain drugs that don't dramatically increase your risk of bad Coronavirus events. In fact, there are probably some drugs that may even lower your risk. That all needs to be validated and in a randomized control and we need to have the proper FDA approvals and things of that nature. But I think our study can be very reassuring and actually generate new hypotheses so that people understand Coronavirus better.

I want to thank you for your research. It's also a good reminder that we know many patients have not come in for their cancer screenings and there is a concern about diagnoses that we might be missing or that presenting much later. Can you just remind our audience the importance of screening as well as the importance of vaccination for those people that do have cancer?

Absolutely. Now we know with the highest level of confidence that vaccination is the best thing you can do to stay safe and keep your family and loved ones safe from Coronavirus. So it's incredibly important, especially patients who are at high risk of Coronavirus-- bad outcomes like patients with cancer, patients with an immune system that isn't fully strengthened.

So please get vaccinated and please use common sense to stay away from folks who are sick. If you're feeling sick, please do get screened. Please, if you have any concern that you've encountered someone with Coronavirus, please get screened and tested for the disease. We all have a role to play to help the health of our country and get us going again in the right direction.

Dr. Foote, I want to thank you again for taking your time to chat with us about the role of cancer drugs and perhaps helping to fight COVID.

No, thank you so much for the opportunity. And I hope everyone stays safe and as well.

And if you have questions about COVID, drop us a line. You can email me at [email protected].