Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre – including this research content – immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. present, no vaccines or drugs have been approved for its treatment. ? According to population-based analyses, oncologic patients might have a greater risk of developing COVID-19 and poorer outcomes compared with those without cancer. ? In the present report, we have described the case of a patient with nonCsmall-cell lung cancer undergoing chemoimmunotherapy who developed COVID-19 pneumonia. ? He was MK-447 treated with tocilizumab and showed significant improvement after the first dose; nonCacute side effects were observed. ? More data from patients undergoing chemoimmunotherapy and affected by COVID-19 are required to draw definitive conclusions. ? However, the clinical outcome for our patient suggests that tocilizumab can be safely used to treat COVID-19 pneumonia in patients undergoing chemoimmunotherapy. Introduction Since December 2019, the outbreak of a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing infection with coronavirus disease 2019 (COVID-19) has spread worldwide.1 The number of confirmed cases had reached 16,536,862, including 654,247 deaths, as of July 27, 2020.2 The case fatality rate (number of deaths in persons who tested positive for COVID-19 divided MK-447 by the total number of COVID-19 cases) has been higher for the elderly and those with underlying comorbidities, such as diabetes, chronic respiratory disease, cardiovascular disease, and cancer.3, 4, 5 In addition, increasing evidence has suggested that SARS-CoV-2 infection can induce an aberrant host immune response associated MK-447 with a cytokine storm syndrome, characterized by a massive release of proinflammatory cytokines, including interleukin-6 (IL-6), which has been associated with a worse prognosis.6 , 7 Tocilizumab is a recombinant humanized monoclonal antibody directed against the IL-6 receptor. It has been approved by the European Medicines Agency for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis, and chimeric antigen receptor T-cellCinduced cytokine release syndrome.8 Additionally, tocilizumab has shown efficacy in the treatment of steroid-refractory immune-related adverse events.9 , 10 However, limited data are available for critically ill patients treated with tocilizumab for COVID-19 pneumonia. In a prospective series of 100 consecutive patients admitted to the Spedali Civili University Hospital (Brescia, Italy) with COVID-19 pneumonia and respiratory failure requiring ventilatory support, treatment with tocilizumab was associated with a clinical benefit for more than three quarters of the patients.11 The findings from other observational studies have suggested that tocilizumab might be associated with better outcomes compared with standard care for patients with severe COVID-19. However, randomized clinical trials with larger sample sizes are required confirm this hypothesis.12 In addition, scarce information is available regarding cancer patients and COVID-19. In the present report, we have described our experience with tocilizumab treatment for a patient with stage IV lung adenocarcinoma, who had developed COVID-19 pneumonia after his first cycle of chemoimmunotherapy. Case Report The patient was a 65-year-old man without major comorbidities. He had an Eastern Cooperative Oncology Group performance status of 1 1 and was a former smoker (15 MK-447 pack-years). He had been diagnosed with stage IV lung adenocarcinoma (bilateral lung metastases) in February 2020. He had received a vaccination for seasonal influenza. Based on the radiologic stage and molecular profile (programmed cell death ligand 1, 2%; absence of ALK and ROS translocations, and EGFR and BRAF mutations), he started treatment with carboplatin, pemetrexed, and pembrolizumab on March 6, 2020. On March 13, 2020 (day 1 of admission), he had presented to our outpatient clinic reporting fever in the previous 24 hours and productive cough. On his initial physical examination, he was tachycardic (100 bpm) and febrile (40C), with fine crackles heard at the right lung base. The arterial oxygen partial pressure/fractional inspired oxygen (P/F) ratio in room air was 328. Blood tests showed grade 3 leukopenia and neutropenia and elevation CCM2 of C-reactive protein (CRP; Table?1 ). A chest radiograph did not demonstrate any signs of interstitial pneumonia. A nasopharyngeal swab for COVID-19 was performed. The patient was hospitalized, and treatment with granulocyte colony-stimulating factors and broad-spectrum empirical antibiotics was started. No steroids were administered. The results of reverse transcriptase polymerase chain reaction testing for C-19 nucleic acid were positive on day 2 (24 hours after admission). In accordance with hospital protocol, darunavir 800 mg/d, ritonavir 100 mg/d, and hydroxychloroquine 200 mg twice daily were prescribed. Despite ongoing therapy and oxygen supplementation with a reservoir mask at 15 L/min, his clinical condition did not improve. CRP had increased to 225 mg/L, and his IL-6 level, tested for the first time, was 101 ng/L (Table?1). The results from blood cultures and legionella and pneumococcal.