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Liao K, Cheng J, Hu Y, Zhang B, Huang P, Liu J, Zhang W, Hu H, Bai X, Qian Y, Guo D, Ai K, Zhu Y, Huang L. Evaluation of the safety of PD-1/PD-L1 inhibitors for immunotherapy in patients with malignant tumors after COVID-19 infection: A single-center cohort study. Cancer Med 2024; 13:e70202. [PMID: 39377592 PMCID: PMC11459677 DOI: 10.1002/cam4.70202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/08/2024] [Accepted: 08/26/2024] [Indexed: 10/09/2024] Open
Abstract
INTRODUCTION An increasing body of evidence suggests a close association between COVID-19 infection and the safety of PD-1/PD-L1 inhibitor therapy in cancer patients. However, the available data concerning these impacts remain limited and occasionally contradictory. MATERIAL AND METHODS We conducted a retrospective analysis of cancer patients who received PD-1/PD-L1 inhibitor therapy at the same institution from November 2022 to May 2023. After excluding patients with missing information, a total of 224 cases were included. In our study, immune-related adverse events (irAEs) that occurred during the hospitalization of patients were included in the analysis. Further analysis of inter-subgroup differences was conducted following a 1:2 propensity score matching. Statistical analyses were performed using the Fisher's exact, chi-squared, and Mann-Whitney U-tests. RESULT The results showed that no statistically significant differences between the two subgroups in the incidence of irAEs, changes in immune function before and after using PD-1/PD-L1 inhibitors, and alterations in hepatic and renal function (p > 0.05). CONCLUSION Our findings suggest that infection with COVID-19 does not significantly impact the safety of PD-1/PD-L1 inhibitors in cancer patients. Most cancer patients used PD-1/PD-L1 inhibitors during COVID-19 infection (asymptomatic or mild infection) did not experience exacerbation of their underlying condition, nor did they exhibit a substantial increase in toxic side effects.
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Affiliation(s)
- Kaili Liao
- Department of Clinical Laboratory, the 2nd Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Jinting Cheng
- School of Public Health, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Yujie Hu
- The 1st Clinical Medical College, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Beining Zhang
- Queen Mary College, Jiangxi Medical College, Nanchang UniversityNanchangChina
| | - Peng Huang
- Department of Oncology, the 2nd Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Jie Liu
- School of Public Health, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Wenyige Zhang
- Queen Mary College, Jiangxi Medical College, Nanchang UniversityNanchangChina
| | - Huan Hu
- School of Public Health, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Xinyi Bai
- School of Public Health, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Yihui Qian
- The 2nd Clinical Medical College, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Daixin Guo
- School of Public Health, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Kun Ai
- Queen Mary College, Jiangxi Medical College, Nanchang UniversityNanchangChina
| | - Yuchen Zhu
- The 1st Clinical Medical College, Jiangxi Medical CollegeNanchang UniversityNanchangChina
| | - Long Huang
- Department of Oncology, the 2nd Affiliated Hospital, Jiangxi Medical CollegeNanchang UniversityNanchangChina
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Pietroluongo E, De Placido P, Picozzi F, Morra R, Tortora M, Del Deo V, Montella L, Palmieri G, Buonomo AR, De Placido S, Gentile I, Giuliano M. Multidisciplinary approach for rare thoracic tumors during COVID-19 pandemic. MEDIASTINUM (HONG KONG, CHINA) 2023; 7:8. [PMID: 36926294 PMCID: PMC10011862 DOI: 10.21037/med-21-47] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/13/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Erica Pietroluongo
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Pietro De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Fernanda Picozzi
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Rocco Morra
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Marianna Tortora
- Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
| | - Vitantonio Del Deo
- Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
| | - Liliana Montella
- ASL NA2 NORD, Oncology Operative Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Italy
| | | | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University Federico II, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.,Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery-Section of Infectious Diseases, University Federico II, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.,Rare Tumors Coordinating Center of Campania Region (CRCTR), Naples, Italy
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Rescigno P, Maruzzo M, Rebuzzi SE, Murianni V, Cinausero M, Lipari H, Fratino L, Gamba T, De Giorgi U, Caffo O, Bimbatti D, Dri A, Mosca A, Giunta EF, Ermacora P, Vignani F, Msaki A, Bonifacio B, Lombardo V, Conteduca V, Basso U, Fornarini G, Banna GL. Adherence to Oral Treatments in Older Patients with Advanced Prostate Cancer, the ADHERE Study: A Prospective Trial of the Meet-URO Network. Oncologist 2022; 27:e949-e956. [PMID: 35920559 PMCID: PMC9732238 DOI: 10.1093/oncolo/oyac147] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Novel androgen receptor signaling inhibitors for prostate cancer (PC) impose the burden of self-administration on older patients overwhelmed by the requirement of many other concomitant medications. PATIENTS AND METHODS This study evaluated the proportion of non-adherence in a 12-month follow-up period and the first 3 months to abiraterone (ABI) or enzalutamide (ENZ). In a prospective multicenter observational cohort study, patients with metastatic castration-resistant PC (mCRPC) aged ≥70 years receiving ABI or ENZ pre- or post-docetaxel were enrolled. Treatment monitoring included pill counting, a self-assessment questionnaire, and clinical diaries at each clinical visit. Non-adherence rates were based on proportions of missed/prescribed pills ratios by pill counting. RESULTS Overall, 234 patients were recruited with median age of 78 years (range, 73-82); 86 (37%) were treated with ABI, and 148 (63%) with ENZ. The median follow-up for adherence was seven monthly cycles (IQR: 4-12). The two cohorts were well balanced for baseline characteristics. The percentage of non-adherence by pill counting was slightly higher for ABI than ENZ (5.2% vs. 4.2%, P < .001). By self-reporting, patients on ENZ tended to report more frequently than those with ABI forgetfulness as the reason for missing events (42% vs. 17%, P < .001). A lower Geriatric G8 score correlated with non-adherence (P = .004). Overall survival (OS) was 48.8 months. Patients on ABI had radiographic progression-free survival (rPFS) of 28.4 [24.2-32.5], while for ENZ patients, we reported a median rPFS of 23.1 [18.2-28.1] months. CONCLUSION Physicians tend to treat older mCRPC patients with ENZ. Non-adherence rate is relatively low overall but can be higher with ABI than with ENZ and correlates with the Geriatric G8 score. Forgetfulness is a potential barrier for ENZ.
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Affiliation(s)
| | - Marco Maruzzo
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy.,Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Genova, Italy
| | - Veronica Murianni
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marika Cinausero
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | - Helga Lipari
- Division of Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Lucia Fratino
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Italy
| | - Teresa Gamba
- Medical Oncology, Mauriziano Hospital,Turin, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Davide Bimbatti
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Arianna Dri
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | | | | | - Paola Ermacora
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | | | - Aichi Msaki
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Barbara Bonifacio
- Department of Oncology, ASUFC Santa Maria Della Misericordia, Udine, Italy
| | | | - Vincenza Conteduca
- Department of Medical and Surgical Sciences, Unit of Medical Oncology and Biomolecular Therapy, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Umberto Basso
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Della Corte CM, Fasano M, Ciaramella V, Cimmino F, Cardnell R, Gay CM, Ramkumar K, Diao L, Di Liello R, Viscardi G, Famiglietti V, Ciardiello D, Martini G, Napolitano S, Tuccillo C, Troiani T, Martinelli E, Wang J, Byers L, Morgillo F, Ciardiello F. Anti-tumor activity of cetuximab plus avelumab in non-small cell lung cancer patients involves innate immunity activation: findings from the CAVE-Lung trial. J Exp Clin Cancer Res 2022; 41:109. [PMID: 35346313 PMCID: PMC8962159 DOI: 10.1186/s13046-022-02332-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background We recently conducted Cetuximab-AVElumab-Lung (CAVE-Lung), a proof-of-concept, translational and clinical trial, to evaluate the combination of two IgG1 monoclonal antibodies (mAb): avelumab, an anti-PD-L1 drug, and cetuximab, an anti-epidermal growth factor receptor (EGFR) drug, as second- or third-line treatment in non-small cell lung cancer (NSCLC) patients. We have reported clinically relevant anti-tumor activity in 6/16 patients. Clinical benefit was accompanied by Natural Killer (NK) cell-mediated antibody-dependent cell cytotoxicity (ADCC). Among the 6 responding patients, 3 had progressed after initial response to a previous treatment with single agent anti-PD-1, nivolumab or pembrolizumab. Methods We report long-term clinical follow-up and additional findings on the anti-tumor activity and on the immune effects of cetuximab plus avelumab treatment for these 3 patients. Results As of November 30, 2021, 2/3 patients were alive. One patient was still on treatment from 34 months, while the other two patients had progression free survival (PFS) of 15 and 19 months, respectively. Analysis of serially collected peripheral blood mononuclear cells (PBMC) revealed long-term activation of NK cell-mediated ADCC. Comprehensive genomic profile analysis found somatic mutations and germline rare variants in DNA damage response (DDR) genes. Furthermore, by transcriptomic analysis of The Cancer Genome Atlas (TCGA) dataset we found that DDR mutant NSCLC displayed high STING pathway gene expression. In NSCLC patient-derived three-dimensional in vitro spheroid cultures, cetuximab plus avelumab treatment induced additive cancer cell growth inhibition as compared to single agent treatment. This effect was partially blocked by treatment with an anti-CD16 mAb, suggesting a direct involvement of NK cell activation. Furthermore, cetuximab plus avelumab treatment induced 10-, 20-, and 20-fold increase, respectively, in the gene expression of CCL5 and CXCL10, two STING downstream effector cytokines, and of interferon β, as compared to untreated control samples. Conclusions DDR mutations may contribute to DDR-induced STING pathway with sustained innate immunity activation following cetuximab plus avelumab combination in previously treated, PD-1 inhibitor responsive NSCLC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-022-02332-2.
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Di Cosimo S, Susca N, Apolone G, Silvestris N, Racanelli V. The worldwide impact of COVID-19 on cancer care: A meta-analysis of surveys published after the first wave of the pandemic. Front Oncol 2022; 12:961380. [PMID: 36249038 PMCID: PMC9556993 DOI: 10.3389/fonc.2022.961380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background The rapid and global spread of COVID-19 posed a massive challenge to healthcare systems, which came across the need to provide high-intensity assistance to thousands of patients suffering from SARS-CoV-2 infection while assuring continuous care for all other diseases. This has been of particular importance in the oncology field. This study explores how oncology centers responded to the pandemic at a single center level by assessing surveys addressing different aspects of cancer care after the pandemic outbreak. Methods We performed a systematic review and meta-analysis of the cancer care surveys published until December 11th, 2020. Data were analyzed according to three main areas of interest, namely health care organization, including cancellation/delay and/or modification of scheduled treatments, cancellation/delay of outpatient visits, and reduction of overall cancer care activities; routine use of preventive measures, such as personal protective equipment (PPE) by both patients and health care workers, and systematic SARS-CoV-2 screening by nasopharyngeal swabs; and implementation of telemedicine through remote consultations. Findings Fifty surveys reporting data on 9150 providers from 121 countries on 5 continents were included. Cancellation/delay of treatment occurred in 58% of centers; delay of outpatient visits in 75%; changes in treatment plans in 65%; and a general reduction in clinical activity in 58%. Routine use of PPE by patients and healthcare personnel was reported by 81% and 80% of centers, respectively; systematic SARS-CoV-2 screening by nasopharyngeal swabs was reported by only 41% of centers. Virtual visits were implemented by the majority (72%) of centers. Interpretation These results describe the negative impact of COVID-19 on cancer care, the rapid response of cancer centers in terms of preventive measures and alternative treatment approaches such as telemedicine, and confirm that surveys can provide the valuable, low-cost and immediate information that critical situations require.
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Affiliation(s)
- Serena Di Cosimo
- Platform of Integrated Biology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Susca
- School of Medicine: Interdisciplinary of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy
| | - Vito Racanelli
- School of Medicine: Interdisciplinary of Medicine, Aldo Moro University of Bari, Bari, Italy
- *Correspondence: Vito Racanelli,
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6
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Micek A, Diehl K, Teuscher M, Schaarschmidt M, Sasama B, Ohletz J, Burbach G, Kiecker F, Hillen U, Harth W, Peitsch WK. Melanoma care during one year pandemic in Berlin: decreasing appointment cancellations despite increasing COVID-19 concern. J Dtsch Dermatol Ges 2022; 20:962-978. [PMID: 35665996 PMCID: PMC9348098 DOI: 10.1111/ddg.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic poses a great challenge for cancer patients. Our aim was to assess its influence on treatment and appointments of melanoma patients after one year of pandemic. METHODS Melanoma patients treated in the Vivantes Skin Cancer Centre in Berlin, Germany completed a postal survey on pandemic-related alterations in melanoma care. Impact factors on changes of appointments were examined with descriptive analyses and multivariate logistic regression. Data after one year of pandemic were compared to those after its first wave. RESULTS Among 366 participants (57.7 % males; mean age 69.2 years, response rate: 36.1 %), 38 (10.1 %) reported postponed or missed appointments, mostly on their own demand (71.1 %) due to fear of COVID-19 (52.6 %). Current treatment was associated with a lower risk of changing appointments (Odds Ratio [OR]: 0.194, p = 0.002), higher age (OR: 1.037, p = 0.039), longer disease duration (OR: 1.007, p = 0.028), and higher school degree (OR: 2.263, p = 0.043) with higher probability. Among 177 patients currently receiving therapy, only 1.7 % experienced pandemic-related treatment alterations. Concern about COVID-19 was significantly higher after one year of pandemic than after its first wave, but the number of missed appointments was lower. CONCLUSIONS Pandemic-related changes were rare in our cohort and decreased over time despite increasing concern.
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Affiliation(s)
- Aleksandra Micek
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany,Faculty of Medicine, CharitéUniversity Medicine BerlinBerlinGermany
| | - Katharina Diehl
- Mannheim Institute of Public HealthSocial and Preventive MedicineMedical Faculty MannheimHeidelberg UniversityMannheimGermany,Department of Medical InformaticsBiometry and EpidemiologyFriedrich‐Alexander‐University Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Miriam Teuscher
- Department of Dermatology and PhlebologyVivantes Klinikum im FriedrichshainBerlinGermany
| | - Marthe‐Lisa Schaarschmidt
- Department of DermatologyVenereology and AllergologyUniversity Medical Center MannheimHeidelberg UniversityMannheimGermany
| | - Bianca Sasama
- Department of Dermatology and PhlebologyVivantes Klinikum im FriedrichshainBerlinGermany
| | - Jan Ohletz
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany
| | - Guido Burbach
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany
| | - Felix Kiecker
- Department of Dermatology and VenereologyVivantes Klinikum NeuköllnBerlinGermany
| | - Uwe Hillen
- Department of Dermatology and VenereologyVivantes Klinikum NeuköllnBerlinGermany
| | - Wolfgang Harth
- Department of Dermatology and AllergologyVivantes Klinikum SpandauBerlinGermany
| | - Wiebke K. Peitsch
- Department of Dermatology and PhlebologyVivantes Klinikum im FriedrichshainBerlinGermany
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7
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Micek A, Diehl K, Teuscher M, Schaarschmidt ML, Sasama B, Ohletz J, Burbach G, Kiecker F, Hillen U, Harth W, Peitsch WK. Melanomversorgung während eines Jahres Pandemie in Berlin: abnehmende Terminstornierungen trotz zunehmender Besorgnis über COVID-19. J Dtsch Dermatol Ges 2022; 20:962-979. [PMID: 35881087 PMCID: PMC9350167 DOI: 10.1111/ddg.14799_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
HINTERGRUND UND ZIELE Die COVID-19-Pandemie stellt für Krebspatienten eine große Herausforderung dar. Unser Ziel war es, ihren Einfluss auf die Behandlung und auf Arzttermine von Melanompatienten nach einem Jahr Pandemie zu untersuchen. PATIENTEN UND METHODIK Melanompatienten, die im Vivantes Hauttumorzentrum in Berlin behandelt wurden, beantworteten eine postalische Umfrage zu Pandemie-bedingten Änderungen ihrer Melanomversorgung. Einflussfaktoren auf Terminänderungen wurden mit deskriptiven Analysen und multivariater logistischer Regression untersucht. Daten nach einem Jahr Pandemie wurden mit Daten nach der ersten Welle verglichen. ERGEBNISSE Von den 366 Teilnehmern (57,7 % Männer; Durchschnittsalter 69,2 Jahre, Rücklaufquote: 36,1 %) berichteten 38 (10,1 %) über verschobene oder verpasste Arzttermine, meist auf eigenen Wunsch (71,1 %) aus Angst vor COVID-19 (52,6 %). Eine aktuelle Therapie war mit einem geringeren Risiko, Termine zu verpassen, assoziiert (Odds Ratio [OR]: 0,194, p = 0,002), höheres Alter (OR: 1,037, p = 0,039), längere Krankheitsdauer (OR: 1,007, p = 0,028) und ein höherer Schulabschluss (OR: 2,263, p = 0,043) mit höherer Wahrscheinlichkeit. Von den 177 Patienten, die aktuell eine Therapie erhielten, erfuhren nur 1,7 % Pandemie-bedingte Behandlungsänderungen. Die Besorgnis über COVID-19 war nach einem Jahr Pandemie signifikant größer als nach der ersten Welle, die Zahl der verpassten Arzttermine jedoch niedriger. SCHLUSSFOLGERUNGEN Pandemie-bedingte Änderungen waren in unserer Kohorte selten und nahmen trotz zunehmender Besorgnis mit der Zeit ab.
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Affiliation(s)
- Aleksandra Micek
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin.,Medizinische Fakultät, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Katharina Diehl
- Mannheimer Institut für Public Health, Sozial- und Präventivmedizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim.,Institut für Medizininformatik, Biometrie und Epidemiologie, Professur für Epidemiologie und Public Health, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
| | - Miriam Teuscher
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin
| | - Marthe-Lisa Schaarschmidt
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim
| | - Bianca Sasama
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin
| | - Jan Ohletz
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin
| | - Guido Burbach
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin
| | - Felix Kiecker
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | - Wolfgang Harth
- Klinik für Dermatologie und Allergologie, Vivantes Klinikum Spandau, Berlin
| | - Wiebke K Peitsch
- Klinik für Dermatologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin
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8
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Jiang M, Hu Y, Lin G, Chen C. Dosing Regimens of Immune Checkpoint Inhibitors: Attempts at Lower Dose, Less Frequency, Shorter Course. Front Oncol 2022; 12:906251. [PMID: 35795044 PMCID: PMC9251517 DOI: 10.3389/fonc.2022.906251] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a revolutionary breakthrough in the field of cancer by modulating patient's own immune system to exert anti-tumor effects. The clinical application of ICIs is still in its infancy, and their dosing regimens need to be continuously adjusted. Pharmacokinetic/pharmacodynamic studies showed a significant plateau in the exposure-response curve, with high receptor occupancy and plasma concentrations achieved at low dose levels. Coupled with concerns about drug toxicity and heavy economic costs, there has been an ongoing quest to reevaluate the current ICI dosing regimens while preserving maximum clinical efficacy. Many clinical data showed remarkable anticancer effects with ICIs at the doses far below the approved regimens, indicating the possibility of dose reduction. Our review attempts to summarize the clinical evidence for ICIs regimens with lower-dose, less-frequency, shorter-course, and provide clues for further ICIs regimen optimization.
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Affiliation(s)
| | | | | | - Chao Chen
- Department of Radiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
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9
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Davis CH, Ho J, Greco SH, Koshenkov VP, Vidri RJ, Farma JM, Berger AC. COVID-19 is Affecting the Presentation and Treatment of Melanoma Patients in the Northeastern United States. Ann Surg Oncol 2021; 29:1629-1635. [PMID: 34797482 PMCID: PMC8603898 DOI: 10.1245/s10434-021-11086-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022]
Abstract
Background Covid-19 significantly affected healthcare delivery over the past year, with a shift in focus away from nonurgent care. Emerging data are showing that screening for breast and colon cancer has dramatically decreased. It is unknown whether the same trend has affected patients with melanoma. Methods This is a retrospective cohort study of melanoma patients at two large-volume cancer centers. Patients were compared for 8 months before and after the lockdown. Outcomes focused on delay in treatment and possible resultant upstaging of melanoma. Results A total of 375 patients were treated pre-lockdown and 313 patients were treated post-lockdown (17% decrease). Fewer patients presented with in situ disease post-lockdown (15.3% vs. 17.9%), and a higher proportion presented with stage III-IV melanoma (11.2% vs. 9.9%). Comparing patients presenting 2 months before versus 2 months after the lockdown, there was an even more significant increase in Stage III-IV melanoma from 7.1% to 27.5% (p < 0.0001). Finally, in Stage IIIB-IIID patients, there was a decrease in patients receiving adjuvant therapy in the post lockdown period (20.0% vs. 15.2%). Conclusions As a result of the recent pandemic, it appears there has been a shift away from melanoma in situ and toward more advanced disease, which may have significant downstream effects on prognosis and could be due to a delay in screening. Significantly patients have presented after the lockdown, and fewer patients are undergoing the recommended adjuvant therapies. Patient outreach efforts are essential to ensure that patients continue to receive preventative medical care and screening as the pandemic continues.
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Affiliation(s)
- Catherine H Davis
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Jason Ho
- Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Stephanie H Greco
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Vadim P Koshenkov
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA
| | - Roberto J Vidri
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jeffrey M Farma
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Adam C Berger
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA. .,Rutgers Robert Wood Johnson University Medical School, New Brunswick, NJ, USA.
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10
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van Not OJ, van Breeschoten J, van den Eertwegh AJM, Hilarius DL, De Meza MM, Haanen JB, Blank CU, Aarts MJB, van den Berkmortel FWPJ, de Groot JWB, Hospers GAP, Ismail RK, Kapiteijn E, Piersma D, van Rijn RS, Stevense-den Boer MAM, van der Veldt AAM, Vreugdenhil G, Boers-Sonderen MJ, Blokx WAM, Suijkerbuijk KPM, Wouters MWJM. The unfavorable effects of COVID-19 on Dutch advanced melanoma care. Int J Cancer 2021; 150:816-824. [PMID: 34605003 PMCID: PMC8652896 DOI: 10.1002/ijc.33833] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/23/2021] [Accepted: 08/09/2021] [Indexed: 12/21/2022]
Abstract
The COVID‐19 pandemic had a severe impact on medical care. Our study aims to investigate the impact of COVID‐19 on advanced melanoma care in the Netherlands. We selected patients diagnosed with irresectable stage IIIc and IV melanoma during the first and second COVID‐19 wave and compared them with patients diagnosed within the same time frame in 2018 and 2019. Patients were divided into three geographical regions. We investigated baseline characteristics, time from diagnosis until start of systemic therapy and postponement of anti‐PD‐1 courses. During both waves, fewer patients were diagnosed compared to the control groups. During the first wave, time between diagnosis and start of treatment was significantly longer in the southern region compared to other regions (33 vs 9 and 15 days, P‐value <.05). Anti‐PD‐1 courses were postponed in 20.0% vs 3.0% of patients in the first wave compared to the control period. Significantly more patients had courses postponed in the south during the first wave compared to other regions (34.8% vs 11.5% vs 22.3%, P‐value <.001). Significantly more patients diagnosed during the second wave had brain metastases and worse performance status compared to the control period. In conclusion, advanced melanoma care in the Netherlands was severely affected by the COVID‐19 pandemic. In the south, the start of systemic treatment for advanced melanoma was more often delayed, and treatment courses were more frequently postponed. During the second wave, patients were diagnosed with poorer patient and tumor characteristics. Longer follow‐up is needed to establish the impact on patient outcomes.
What's new?
Little is known about the effects of COVID‐19 on advanced melanoma care. In this study, the authors examined several quality indicators of care. They observed a worsening in baseline characteristics, longer time between diagnosis and start of treatment and more postponed anti‐PD‐1 antibody courses with differences between the northern, middle and southern regions. Future studies are necessary to assess the long‐term consequences of our observed changes in advanced melanoma care.
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Affiliation(s)
- Olivier J van Not
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jesper van Breeschoten
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Alfonsus J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Doranne L Hilarius
- Department of Pharmacy, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Melissa M De Meza
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - John B Haanen
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian U Blank
- Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, GROW School of Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rawa K Ismail
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Djura Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Rozemarijn S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | | | - Astrid A M van der Veldt
- Department of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, Eindhoven, The Netherlands
| | - Marye J Boers-Sonderen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Michel W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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11
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Mintoff D, Chatterjee M, Podder I, Shipman A, Das A. Clinical Dermatology and COVID-19 Pandemic: Narrative Review. Indian J Dermatol 2021; 66:246-255. [PMID: 34446947 PMCID: PMC8375546 DOI: 10.4103/ijd.ijd_463_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The coronavirus disease of 2019 (COVID-19) pandemic has radical repercussions on every aspect of medical science, including dermatology. The magnitude of the impact on clinical dermatology cannot be overemphasized. Dermatologists have been forced to modify and reconsider the way they consult patients. Teledermatology has come up in a big way, with most of the clinicians resorting to technology and software-based consultations. Management of different dermatological conditions like papulosquamous disorders, vesiculobullous disorders, malignancies, etc., needs to be modified as per the different recommendations proposed by expert panels. This review is an attempt to highlight the impact of this destructive pandemic on various aspects of clinical dermatology.
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Affiliation(s)
- Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | | | - Indrashis Podder
- Department of College of Medicine and Sagore Dutta Hospital, India
| | - Alexa Shipman
- Department of Portsmouth Hospitals University NHS Trust, UK
| | - Anupam Das
- Department of KPC Medical College and Hospital, Kolkata, West Bengal, India
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12
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Krawczyk P, Kowalski DM, Wojas-Krawczyk K, Dziadziuszko R. Predictive factors testing proposal for NSCLC patients during the COVID-19 pandemic. Expert Rev Anticancer Ther 2021; 21:569-572. [PMID: 33724132 DOI: 10.1080/14737140.2021.1901585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Paweł Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Chest Tumors, The Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Kamila Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Rafał Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
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13
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Hoffmann TK, Greve J, Laban S, Schuler PJ. [Treatment of patients with head and neck cancer during the COVID-19 pandemic]. HNO 2020; 69:14-16. [PMID: 33170312 PMCID: PMC7653450 DOI: 10.1007/s00106-020-00967-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/19/2022]
Affiliation(s)
- T K Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland.
| | - J Greve
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland
| | - S Laban
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland
| | - P J Schuler
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Frauensteige 12, 89081, Ulm, Deutschland
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