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International Journal of Molecular & Immuno Oncology • Article in Press | 1
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©2020 Published by Scientic Scholar on behalf of International Journal of Molecular & Immuno Oncology
Short Communication
Outcome of ivermectin and doxycycline in cancer
patients with COVID-19: A positive experience in
Bangladesh
Syed Md Akram Hussain1, Md Shuayb2, Mahmudur Rahman3
1Department of Oncology, Square Hospitals, West Panthapath, Dhaka, Bangladesh, 2Vancouver Prostate Centre, Vancouver General Hospital, e University of
British Columbia, Vancouver, Canada, 3Emerging Infections Program, IDD, International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
*Corresponding author:
Syed Md Akram Hussain,
Department of Oncology,
Square Hospitals,
WestPanthapath, Dhaka,
Bangladesh.
syedmdakram@gmail.com
Received : 17 September 2020
Accepted : 20 October 2020
Published :
DOI:
10.25259/IJMIO_30_2020
Quick Response Code:
e world, today, is facing an immense challenge with the outbreak of severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) infection known as coronavirus disease 2019
(COVID-19). Bangladesh is the 16th ranked pandemic part of the world with 244,020 cases
diagnosed and 3234 deaths to date.[1] At present, no FDA approved remedies are available to defeat
this deadly disease. Ivermectin, an antiparasitic drug, has been found to inhibit the replication
of the SARS-CoV-2 virus in vitro.[2] When combined with doxycycline, an antibacterial drug,
ivermectin showed encouraging activity in reducing viral load, possible molecular mechanisms
of which have been proposed very recently.[3,4] Globally, a number of clinical trials are going on
to explore the activity of these two widely used FDA approved drugs as a potential therapy for
SARS-CoV-2 infection.
Although no systematic data are available, several studies including the European Society for
Medical Oncology and the National Institute for Health and Care Excellence guidelines have
reported that cancer patients are more vulnerable to develop COVID-19 infection.[5] We sought
to investigate the eectiveness of ivermectin plus doxycycline in COVID-19-positive cancer
patients in a tertiary care cancer center of Dhaka city in Bangladesh.
is is a case series conducted at the Oncology and Radiotherapy Centre of Square Hospital,
Bangladesh. A total of eight patients were treated with ivermectin and doxycycline combination
to date, who met the eligibility criteria. e primary outcome was treatment response and the
secondary outcome was treatment-related toxicity. Inclusion criteria included in this study were
patients with any stage of solid malignancies or lymphoma proved by pathology; active disease
being treated with chemotherapy and/or radiotherapy, biological agent, hormone therapy, or
immunotherapy in neoadjuvant, adjuvant, concurrent or palliative setting; ECOG performance
status 0–2; age between 18 and 75 years; RT-PCR positive for SARS-CoV-2; have any of the
symptoms of temperature ≥37.5℃, cough, or sore throat; and provided informed written
consent. e exclusion criteria were allergy to ivermectin or doxycycline; received ivermectin,
doxycycline, hydroxychloroquine, or chloroquine phosphate within the past 4 weeks; a history
of chronic heart, liver, or kidney diseases; pregnant or lactating women; multiple primary
malignancies; and joined in other clinical trials.
When came to our outpatient department for their scheduled cancer treatment, RT-PCR for
COVID-19 was done as per the routine protocol of the hospital. No patient was found to be
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Hussain, et al.: Ivermectin in cancer patients with COVID-19
International Journal of Molecular & Immuno Oncology • Article in Press | 2
impaired immune systems, that is, no leukocytopenia,
thrombocytopenia, or not receiving immunosuppressants.
All presented with mild symptoms of COVID-19 [Table1].
Scheduled treatment (chemotherapy and/or radiotherapy)
was postponed, once COVID-19 was conrmed and started
tablet ivermectin (12 mg for patients with 80 kg weight
and 18 mg for those with above 80 kg weight) single dose
and Tablet doxycycline (100 mg) twice daily for 5 days.
Parallelly, the patients received supportive management
for their symptoms. On day 6, nasal swabs were collected
for RT-PCR for SARS-CoV-2 which appeared negative
for all patients, and the consecutive test was done on day 7
also appeared negative. All patients became free from the
symptoms of COVID-19 aer this period. en, their cancer
treatment was resumed with intensive surveillance. ere
was no reported toxicity of epigastric distress, abdominal
discomfort, vomiting, diarrhea, or skin rash.
e World Health Organization estimated that the period
of this viral shedding is up to 9 days and 20 days for
the patients with mild symptoms and for those who are
hospitalized, respectively.[1] We report data of eight SARS-
CoV-2-infected cancer patients who were treated with
ivermectin and doxycycline combination and recovered in 6
days only. In addition, our patients remained non-infectious
to other people in the hospital as the successive two PCR
tests were negative. Ongoing oncological managements
were not compromised for any of the patients, except the
5-day treatment delay over the duration of ivermectin plus
doxycycline therapy. All patients were able to complete
the remainder of their chemotherapy and/or radiotherapy
without any serious adverse events.
Managing cancer patients are challenging in the era of
COVID-19 of today. Despite the fact that the risk/benet
ratio of cancer treatment is important without imposing the
patients of being further immunosuppressed and seriously
ill from SARS-CoV-2 infection, cancer-related mortality
must not be ignored. Especially for curable cancers, the
continuation of active oncological management is crucial to
achieve cure and survival benets. Alteration of treatment
regimens, switching to oral treatment, long-term treatment
breaks all can seriously threaten the treatment outcome of
cancer patients even for those who are in palliative settings.
Ivermectin plus doxycycline therapy, though tested in a
very small number of patients in our study, resulted in very
promising activity against COVID-19, and this is the rst-
ever data yield from cancer patients. We believe that our
preliminary ndings could be used as a building block for
future large-scale studies, and randomized controlled trials
including only cancer patients are warranted to validate the
ecacy of this therapy.
Declaration of patient consent
e authors certify that they have obtained all appropriate
patient consent.
Financial support and sponsorship
Nil.
Conicts of interest
ere are no conicts of interest.
Table1: Characteristics of COVID-19-infected cancer patients treated with oral ivermectin plus doxycycline.
Patient Diagnosis Stage Age Comorbidity Ongoing cancer treatment COVID-19
symptoms
Case 1 Gestational
trophoblastic tumor
FIGOa Prognostic
score III
35 Nil 2 weekly intramuscular methotrexate Fever
Case 2 Breast cancer IIB 60 Nil Adjuvant chemotherapy with doxorubicin
and cyclophosphamide
Fever
Case 3 Head and neck
cancer
II 60 DMb, HTNcDenitive CCRTd with weekly cisplatin Fever and
cough
Case 4 Breast cancer IIB 40 Nil Adjuvant chemotherapy with doxorubicin
and cyclophosphamide
Fever and
mild cough
Case 5 Breast cancer IIIC 62 DMbAdjuvant chemotherapy with epirubicin
and cyclophosphamide
Fever
Case 6 Lung cancer IIIC 70 HTNcCCRTd with weekly paclitaxel and
carboplatin
Fever and
cough
Case 7 Biliary tract cancer IIIB 67 DMb, HTNcAdjuvant chemotherapy with 4 weekly
gemcitabine
Fever
Case 8 Breast cancer IIIC 53 Nil Adjuvant endocrine therapy with letrozole Fever, mild
cough
aFIGO: International Federation of Gynecology and Obstetrics, bDM: Diabetes mellitus, cHTN: Hypertension, dCCRT: Concurrent chemoradiation therapy
Hussain, et al.: Ivermectin in cancer patients with COVID-19
International Journal of Molecular & Immuno Oncology • Article in Press | 3
REFERENCES
1. WHO Coronavirus Disease (COVID-19) Dashboard. World
Health Organization. Available from: https://www.covid19.
who.int. [Last accessed on 2020 Aug 10].
2. Caly L, Druce JD, Catton MG, Jans DA, Wagsta KM. e
FDA-approved drug ivermectin inhibits the replication of
SARS-CoV-2 in vitro. Antiviral Res 2020;178:104787.
3. Maurya DK. A Combination of Ivermectin and Doxycycline
Possibly Blocks the Viral Entry and Modulate the Innate
Immune Response in COVID-19 Patients. New York:
ChemRxiv; 2020.
4. Hussman JP. Cellular and Molecular Pathways of COVID-19
and Potential Points of erapeutic Intervention. Front
Pharmacol 2020;11:1169.
5. Cortiula F, Pettke A, Bartoletti M, Puglisi F, Helleday T.
Managing COVID-19 in the oncology clinic and avoiding the
distraction eect. Ann Oncol 2020;31:553-5.
How to cite this article: Hussain SM, Shuayb M, Rahman M. Outcome of
ivermectin and doxycycline in cancer patients with COVID-19: A positive
experience in Bangladesh. Int J Mol Immuno Oncol, doi: 10.25259/
IJMIO_30_2020
