Coronavirus, in Naples the anti-arthritis drug that gives hope. The oncologist: It works, give it to all the sick.
If the CT scan to which a coronavirus patient will be subjected today will demonstrate that pneumonia is going away, it will mean that the path that doctors are following at the Cotugno hospital in Naples to treat serious patients is perhaps the right one. Paolo Ascierto, president of the Melanoma Foundation and Director of the Unit of Oncology Melanoma, Cancer Immunotherapy and Innovative Therapies of the Istituto Nazionale Tumori Irccs Fondazione Pascale of Naples until yesterday evening wanted to keep the maximum confidentiality on the conditions of the patients, so far six, subjected to a experimental therapy, which is giving encouraging results. Although entrenched behind a cautious optimism, in the end he let himself go: "Let's hope it works, it is clear that I can only be happy for the patients". And it would have all the reasons given that the intuition to administer to the infected and in serious conditions a drug generally used for rheumatoid arthritis was all his.
Immunotherapy.
I am an oncologist, I deal with immunotherapy - he said -. The drug that I thought might be useful is tocilizumab, which is used for rheumatoid arthritis. In fact, we who do immunotherapy use it in toxicities from some important immunotherapies, such as for example Car-T that have side effects, including the cytokine release syndrome, which are protein molecules. When we induce a strong activation of the immune system, many are produced.
Among these, interleukin 6, a cytokine capable of stimulating acute inflammation, which is the most important in giving side effects. "This cytokine release syndrome, which gives hypotension and a number of other effects, also causes respiratory distress, which leads to a respiratory insufficiency very similar to that which is triggered by a coronavirus infection.
In short, it happens that in our lung, which is full of macrophages, a sort of battle is unleashed. "When thevirus enters the lungs, the cells of the immune system react to try to kill the virus, but they produce so many cytokines that at a certain point these do more harm than good, and interleukin 6 also becomes important here.
The intuition at this point was providential. And also the comparison with other Chinese scientists with whom Ascierto has contacts. "They told us that not only ours is a great idea, but that they too had treated 21 patients with the same drug, and all of them recovered." Result: two of the most critical patients selected at Cotugno, one intubated and one from the ward, over 60 years old, in less than 24 hours had a significant improvement in respiratory parameters.
Tocilizumab can therefore be used in Covid-19 pneumonia only off label, that is, outside the indications for which it is registered. The pharmaceutical company Roche will provide it for free. Now also other hospitals, including San Raffaele in Milan, Sacco, Brescia and Fano are trying to test tocilizumab. And here too the results bode well. "They told me that a patient had improvements in Fano - Ascierto says -. It must be said that this drug does not act against the virus, but against the complication of the virus. Therefore vaccines obviously remain important for the virus.
THE VALIDATION
The positive results of tocilizumab must obviously be validated, therefore a multicenter study at national level is needed. Our structure together with the Colli Hospital was the first in Italy to use this therapy in patients with coronavirus. But a national protocol is immediately needed to extend the use of tocilizumab in patients infected with coronavirus and who are in very critical conditions. It is very important that its use is extended as soon as possible, so we can save more lives.
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