A Caveats, Nuances and Benefits of the Clinical Use of granulocyte Colony-Stimulating Factors in Cancer Patients with Coronavirus Disease 2019.

Abstract

The rapid escalation of the Coronavirus Disease 2019 (COVID19) pandemic has prompted the reformulation of a number of clinical protocols for cancer management, to reduce the hospital admissions and dampen the risk of severe acute respiratory syndrome coronavirus 2 (SARScov2) infection. Multiple clinical guidelines have emphasized the need to reinforce the supportive care delivery during the pandemic, including the recommendations to expand the use of granulocyte colony stimulating factors (CSFs) in the prophylaxis and treatment of febrile neutropenia. However, the role of CSFs in the pathogenesis of COVID19 has not been fully elucidated and concerns have been raised for its extensive use in the pandemic era. The role of granulocyte CSFs in COVID19 has been reviewed, along with clinical data on the pharmacological manipulation of CSFs in cancer patients and COVID19. CSFs seem to provide a protective role in the initial phases of SARScov2 infection, enhancing the antiviral immune- response. However, in patients experiencing a hyperinflammatory phenotype of COVID19, CSFs effects appear detrimental. In addition, clinical studies seem to suggest that the use of CSFs in the earlier stage of COVID19 has a favorable safety profile. In opposition, CSFs used in cancer patients with febrile neutropenia may worsen the COVID19 course and accelerate the progression to a more severe phenotype. A number of clinical trials is ongoing, with either agonists or antagonists of the CSFs, thus expected to inform on the opportunity to revise the clinical recommendations on CSFs in cancer patients. To date, no major disruptions of the clinical cancer care should be pursued, enhancing a value- based approach in the priority-setting for oncological treatments during the COVID19 pandemic, including the best supportive care.