Lung Cancer and SARS-CoV-2 infection: Identifying important knowledge gaps for investigation

Patients with lung cancer are especially vulnerable to COVID-19 with a >7-fold higher rate of becoming infected with SARS-CoV-2 COVID-19, a >3-fold higher hospitalization rate with high complication rates, and an estimated case fatality rate of over 30%. The reasons for the increased vulnerability are not known. In addition, beyond the pandemic's direct impact on morbidity and mortality among patients with lung cancer, COVID-19, with its disruption of patient care, has also resulted in substantial impact on lung cancer screening and treatment/management. COVID-19 vaccines are safe and effective in people with lung cancer. Based on the available data, patients with lung cancer should continue their course of cancer treatment and get vaccinated against the SARS-CoV-2 virus. For unknown reasons, some patients with lung cancer mount poor antibody responses to vaccination. Thus, boost vaccination seems urgently indicated in this subgroup of vulnerable lung cancer patients. However, many unanswered questions regarding vaccination in this population remain, including the magnitude, quality, and duration of antibody response, and the role of innate and acquired cellular immunity for clinical protection. Additional important knowledge gaps also remain including: how can we best protect patients with lung cancer from developing COVID-19 including managing lung cancer patient care and the home environment of lung cancer patients; are there clinical/treatment demographics and tumor molecular demographics that impact severity of COVID-19 disease in lung cancer patients; does anticancer treatment impact antibody production and protection; does SARS-CoV-2 infection impact the development/progression of lung cancer; and are special measures and vaccine strategies need for patients with lung cancer as viral variants of concern emerge.