Is Paxlovid (nirmatrelvir/ritonavir) advised for patients with cancer?

From the Guidelines

Paxlovid is advised for cancer patients with COVID-19, as it has shown effectiveness in reducing hospitalization and death in high-risk individuals, including those with hematological malignancies or haematopoietic cell transplantation, as suggested by the 2021 European Conference on Infections in Leukaemia (ECIL 9) 1. The decision to use Paxlovid in cancer patients should be made on an individual basis, considering the potential benefits and risks, including drug interactions with cancer medications.

• The standard regimen is nirmatrelvir (300 mg) with ritonavir (100 mg) taken together twice daily for 5 days, ideally started within 5 days of symptom onset.
• Cancer patients should be aware of potential drug interactions between Paxlovid and cancer medications, as ritonavir can affect how other drugs are metabolized, and some cancer treatments may need to be temporarily paused or dosages adjusted during Paxlovid treatment.
• Additionally, kidney function is important to assess, as dosage adjustments are needed for patients with moderate kidney impairment, as noted in the study published in the journal Leukemia 1. The use of Paxlovid in cancer patients is supported by data on oral ritonavir-boosted nirmatrelvir, which showed a lower rate of progression to hospitalization or death in symptomatic, non-hospitalized, adult patients with COVID-19 1.
• This combination of antivirals could be beneficial in HM/HSCT patients, although attention to potential drug interactions through CYP3A inhibition should be considered, as highlighted in the study 1. Overall, Paxlovid may be a valuable treatment option for cancer patients with COVID-19, particularly those at high risk for severe outcomes, and healthcare providers should consider its use on a case-by-case basis, taking into account the individual patient's needs and medical history, as recommended by the ECIL 9 guidelines 1.

From the FDA Drug Label

Eligible subjects were 18 years of age and older with at least 1 of the following risk factors for progression to severe disease: ... active cancer, ... The FDA drug label advises PAXLOVID for patients with active cancer as one of the risk factors for progression to severe disease.

• Key points:
  • PAXLOVID is advised for patients with active cancer.
  • The study included patients with active cancer as part of the high-risk group for progression to severe COVID-19.
  • The primary efficacy endpoint was the proportion of subjects with COVID-19 related hospitalization or death from any cause through Day 28. 2

From the Research

Paxlovid for Cancer Patients

• Paxlovid, also known as nirmatrelvir/ritonavir, is an oral antiviral drug used to treat COVID-19 in patients with mild to moderate disease 3.
• There is evidence to suggest that Paxlovid can be effective in treating COVID-19 in immunocompromised patients, including those with cancer 4, 5.
• A study published in the journal Hematological Oncology found that a combination of remdesivir and nirmatrelvir/ritonavir was effective in treating persistent SARS-CoV-2 infection in patients with impaired humoral immunity, including those with B cell malignancies 4.
• Another study published in the International Journal of Infectious Diseases found that a combination of molnupiravir and nirmatrelvir/ritonavir was effective in treating a patient with follicular lymphoma and persistent SARS-CoV-2 infection 5.
• A systematic review and meta-analysis published in the Journal of Infection in Developing Countries found that Paxlovid was effective in reducing hospitalization, all-cause mortality, and intensive care unit admission in patients with COVID-19 6.

Safety and Efficacy

• The safety and efficacy of Paxlovid in cancer patients have not been extensively studied, but available evidence suggests that it can be effective in treating COVID-19 in this population 4, 5.
• However, cancer patients may be at higher risk for adverse events due to their underlying condition and potential interactions with other medications 3.
• Further studies are needed to fully understand the safety and efficacy of Paxlovid in cancer patients.

Treatment Considerations

• Paxlovid should be started within 5 days of symptom onset and given for 5 days' duration 3.
• The drug interactions of Paxlovid, particularly with ritonavir, should be carefully considered in cancer patients who may be taking other medications 3.
• Cancer patients with COVID-19 should be closely monitored for adverse events and treatment outcomes 4, 5.