Immuno-oncology may accelerate the development of treatments for COVID-19

Researchers at Roswell Park Comprehensive Cancer Center have been actively engaged in the effort to develop treatments or other control strategies that can help communities worldwide to address the impacts of the COVID-19 pandemic.

Because viruses such as SARS-CoV-2 and tumors both interact with the immune system, trying to evade both innate and adaptive immunity, expertise in immunotherapy of cancer is deeply relevant in fighting COVID-19.

"For decades, some of the most important and influential advances in treating cancer came from our understanding of infectious diseases and in particular from virology, the study of viruses," notes Roswell Park's Pawel Kalinski, MD, Ph.D., Vice-Chair for Translational Research and Rustum Family Professor for Molecular Therapeutics and Translational Research, lead developer of one of these new COVID-19 treatment strategies.

"Now, those of us working in immuno-oncology may have the opportunity to return the favor and to accelerate the development of treatments for COVID-19 and other infectious diseases."

The opportunity to apply what we know about cancer as we seek a way to treat COVID-19 hinges on the tools that help our bodies to find and destroy cancer.

"The defense mechanisms that allow cancer cells to go undetected sometimes are similar to how viruses hide from the immune system. So applying what we know from virology can help us to identify and exploit weaknesses in SARS CoV-2, the virus that causes COVID-19," says Igor Puzanov, MD, MSci, FACP, Professor of Medicine, Director of Early Phase Clinical Trials, Co-Leader of the Developmental Therapeutics Program and Chief of the Melanoma Section in the Department of Medicine.

Dr. Puzanov, who has been working closely with doctors from Catholic Health and the University at Buffalo (UB) as well as colleagues from Italy and China to make some of the most promising COVID-19 therapies available to patients in and around Western New York, catches us up on these various research efforts.

Sarilumab: New role for anti-inflammatory?

The first investigational treatment for COVID-19 to become available in the Buffalo area was the anti-inflammatory agent sarilumab (also known as Kevzara).

Doctors believe the drug, approved for use by the FDA for moderate to severe rheumatoid arthritis and also as a treatment for lupus, might also help fight inflammation in the lungs -; like that experienced by people suffering from COVID-19 infections.

Dr. Puzanov is the Principal Investigator of a local collaborative group of Roswell Park and UB researchers participating in a national phase 2/3 trial with sarilumab, enrolling close to 2,000 patients to determine how effective sarilumab may be as a treatment for patients with severe or critical COVID-19.

"This treatment builds on work conducted in China and Italy, where doctors used a similar drug, tocilizumab, with positive results," says Dr. Puzanov, co-author of a recent editorial in the journal Translational Medicine on the potential for using tocilizumab and sarliumab as a treatment for COVID-19.

We need more data before we can draw firm conclusions, but we're hopeful that anti-inflammatory drugs like these can help minimize the possibility of long-term lung damage and reduce the amount of time a person may need to be on a ventilator."

Igor Puzanov, MD, MSci, FACP, Study Co-Author, Professor of Medicine, Director of Early Phase Clinical Trials

Repurposing cancer drugs in fight against COVID

One of the most innovative approaches being explored as a possible treatment for COVID-19 originated from Roswell Park.

Dr. Kalinski championed the idea of combining two drugs -; rintatolimod (also known as Ampligen) and interferon alfa-2b (also known as interferon A) -; as a combination approach for cancer immunotherapy.

He has several studies of this two-drug combination underway at Roswell Park in some solid-tumor cancers and, working closely with Brahm Segal, MD, got FDA authorization to assess this combination in patients with both cancer and COVID-19.

"This is an exciting idea. We know these two immune modulators can stimulate the immune system in patients with cancer, and now we want to take it a step forward and see if this combination can also stimulate the immune system of people with COVID," says Dr. Puzanov.

This study is also notable as one of the relatively few investigational approaches targeted toward patients with mild or moderate COVID-19.

"We are conducting our first study of this approach in patients who have both cancer and COVID-19 because they are at higher risk of severe illness," he adds.

"The hope is that, given early, this combination could prevent the virus from taking hold and causing long-term damage, decreasing the severity of the infection and how long it takes people to recover."

Remdesivir Approved for Emergency Use

Antiviral drugs first developed for use in treating other infectious diseases were some of the first therapies to be given to patients with COVID-19.

In early May 2020, the FDA authorized the use of the Ebola drug remdesivir as an emergency option for treating COVID-19 in adults and children hospitalized with severe disease. A small number of patients locally have been treated with this drug.

"Early tests have shown that patients treated with remdesivir spend one-third less time in the hospital for their illnesses. So this is a promising therapy we are eager to see more data on," notes Dr. Puzanov.

Convalescent plasma: All about the antibodies

Roswell Park has also been a regional collection center supporting several hospitals offering patients with COVID-19 a treatment known as convalescent plasma -; plasma infusions from the blood of people who have been treated and cured of their COVID-19 infections, in the hopes that antibodies in their plasma might help others to fight the virus.

George Chen, MD, and Joanne Becker, MD, have been leading this work. They're encouraging people who have successfully been treated for the virus to consider donating their plasma to help others.

"Convalescent plasma has actually been used for decades as a treatment for viral infections. It can be very important in helping us to manage a brand-new disease like COVID-19, and early evidence suggests that it is helping many patients to improve," says Dr. Puzanov.

A search for biomarkers

Roswell Park teams are also hard at work analyzing how the SARS CoV-2 virus affects us in order to give clinical teams and vaccine developers a deeper knowledge of how best to manage and possibly prevent this disease. Kunle Odunsi, MD, Ph.D., FRCOG, FACOG, and Carl Morrison, MD, DVM, are leading an important effort to understand the body's response to COVID-19 infections.

They're applying their expertise in cancer immunotherapy and precision medicine to identify biomarkers that would allow us to identify early those patients who are more likely to progress to a severe case and to require more intensive treatment.

It's a first-of-its-kind effort involving regional and industry partners: Catholic Health, UB, and Thermo Fisher Scientific.

"This is a very creative way to learn more about this virus and this disease using cutting-edge gene-sequencing technology, something that's never been done before with any previous pandemic," says Dr. Puzanov.

"And it could ultimately prove very important as a way to not only improve clinical outcomes for those with COVID-19 but also to make sure that we apply precious medical resources where they are most needed."

Part of ongoing global effort

As the first wave of COVID-19 cases in our region begins to subside, Dr. Puzanov takes stock of the collaborative efforts that have made this diverse collection of research efforts possible.

"We're proud to contribute our knowledge and our expertise in getting new therapies safely to patients through this global effort," he says. "We are helping to advance the world's understanding of this disease and how best to treat it, and we hope that this will translate to greater peace of mind for everyone."

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