Tocilizumab May Have Activity Against COVID-19–Associated Cytokine Storm in Myeloma

Tocilizumab (Actemra) may represent a potential treatment option with double action against cytokine storm due to COVID-19 in a subset of patients with active multiple myeloma and severe infection with the virus, according to data from a literature review presented during the 2nd European Myeloma Network.

Data from the review, which included case reports and series, showed that 8.8% of patients (n = 49) who had severe COVID-19 and multiple myeloma and had received IL-6 inhibitors most frequently received tocilizumab. Of these 49 patients, clinical outcome data were available for 40 patients. Fifty percent of patients (n = 20) died, while 50% (n = 20) survived.

“An interesting aspect to focus on is the potential use of tocilizumab against multiple myeloma,” Nicola Sgherza, MD, of the Division of Hematology at the IRCCS Ospedale Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy, and colleagues, wrote in the poster presentation. “IL-6 is the major growth factor of human myeloma cells through an autocrine or a paracrine mechanism and tocilizumab was reported to inhibit their proliferation in vitro and to be effective in stabilize serum monoclonal protein in patients with systemic diseases and concomitant multiple myeloma.”

Patients with cancer are at increased risk of infection with SARS-CoV-2 compared with those who do not have cancer. Specifically, patients with multiple myeloma are at serious risk of experiencing severe infection because of immunosuppression, immune deregulation, comorbidities, and frequent visits to the hospital.

Although many multicenter studies have been done in patients with multiple myeloma who have COVID-19, no agents have proven to be effective in the prevention or treatment of those with this disease. As such, efforts have been focused on repurposing existing antiviral and anti-inflammatory agents for monotherapy or combination approaches to treat patients with moderate to severe COVID-19 infection.

Of all the approaches under exploration, IL-6 inhibitors have demonstrated the most promise in terms of managing the cytokine storm linked with the development of the usual lung damage and resultant acute respiratory distress syndrome that presents in the most aggressive patterns of SARS-CoV-2 infection.

Based on what is known thus far, authors of the poster believe that further exploration of tocilizumab as a potential treatment option for cytokine storm associated with COVID-19 in patients with multiple myeloma would warrant to be verified.

Reference

1. Sgherza N, Curci P, Strafella V, et al. Implications of interleukin-6 (IL-6)-blockade for severe COVID-19 infections in patients with multiple myeloma. Presented at: 2nd European Myeloma Network; March 3-6, 2021; Virtual. Poster P63.