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Alaeddini M, Etemad-Moghadam S. SARS-Cov-2 infection in cancer patients, susceptibility, outcome and care. Am J Med Sci 2022; 364:511-520. [PMID: 35605680 PMCID: PMC9119956 DOI: 10.1016/j.amjms.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has led to many problems in cancer patients, which in part are due to insufficient knowledge of the exact implications of the virus on these individuals. Perceptions based on known facts about previous pandemics and coronaviruses might not agree with actual real-life experience and objective findings. We present a compilation of scientific facts and actual observations on different aspects of SARS-CoV-2 infection in cancer patients. These patients are at increased risk of viral contraction and have higher chances of severe disease/mortality. The latter is impacted by other factors and is still debated. In contrast to preliminary impressions, the benefits of anti-cancer treatments outweigh their risks and should be continued. Cancer patients generate antibodies in response to vaccination but in lower amounts than healthy people, especially those with hematologic cancers. Boosters, including third doses, have shown increased immune-responses in most patients. Vaccination should be prioritized in these individuals.
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Affiliation(s)
| | - Shahroo Etemad-Moghadam
- Corresponding author at: Shahroo Etemad-Moghadam, Dentistry Research Institute, Dental Research Centre, Ghods St, Enghelab Ave, P.O. Box: 14155-5583; Postal code: 14174, Tehran, Iran
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2
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Arayici ME, Kipcak N, Kayacik U, Kelbat C, Keskin D, Kilicarslan ME, Kilinc AV, Kirgoz S, Kirilmaz A, Kizilkaya MA, Kizmaz IG, Kocak EB, Kochan E, Kocpinar B, Kordon F, Kurt B, Ellidokuz H. Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04191-y. [PMID: 35831763 PMCID: PMC9281353 DOI: 10.1007/s00432-022-04191-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 12/24/2022]
Abstract
Background Cancer patients constitute one of the highest-risk patient groups during the COVID-19 pandemic. In this study, it was aimed to perform a systematic review and meta-analysis to determine both the incidence and ICU (Intensive Care Unit) admission rates and mortality in SARS-CoV-2 infected cancer patients. Methods The PRISMA guidelines were closely followed during the design, analysis, and reporting of this systematic review and meta-analysis. A comprehensive literature search was performed for the published papers in PubMed/Medline, Scopus, medRxiv, Embase, and Web of Science (WoS) databases. SARS-CoV-2 infection pooled incidence in the cancer populations and the risk ratio (RR) of ICU admission rates/mortality in cancer and non-cancer groups, with 95% confidence intervals (CIs), were calculated using the random-effects model. Results A total of 58 studies, involving 709,908 participants and 31,732 cancer patients, were included in this study. The incidence in cancer patients was calculated as 8% (95% CI: 8–9%). Analysis results showed that mortality and ICU admission rate was significantly higher in patients with cancer (RR = 2.26, 95% CI: 1.94–2.62, P < 0.001; RR = 1.45, 95% CI: 1.28–1.64, p < 0.001, respectively). Conclusion As a result, cancer was an important comorbidity and risk factor for all SARS-CoV-2 infected patients. This infection could result in severe and even fatal events in cancer patients. Cancer is associated with a poor prognosis in the COVID-19 pandemic. Cancer patients should be assessed more sensitively in the COVID-19 outbreak. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-04191-y.
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Affiliation(s)
- Mehmet Emin Arayici
- Department of Preventive Oncology, Institute of Health Sciences, Dokuz Eylul University, 15 July Medicine and Art Campus, Inciralti-Balcova 35340, Izmir, Turkey
| | - Nazlican Kipcak
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ufuktan Kayacik
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Cansu Kelbat
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Deniz Keskin
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Ahmet Veli Kilinc
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sumeyye Kirgoz
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Anil Kirilmaz
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Melih Alihan Kizilkaya
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Irem Gaye Kizmaz
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Enes Berkin Kocak
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Enver Kochan
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Begum Kocpinar
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Fatmanur Kordon
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Batuhan Kurt
- Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- Department of Preventive Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
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3
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Fazilat-Panah D, Fallah Tafti H, Rajabzadeh Y, Fatemi MA, Ahmadi N, Jahansouz D, Tabasi M, Javadinia SA, Joudi M, Harati H, Attarian F, Taghizadeh-Hesary F. Clinical Characteristics and Outcomes of COVID-19 in 1290 New Cancer Patients: Single-center, Prospective Cohort Study from Iran. Cancer Invest 2022; 40:505-515. [PMID: 35521692 DOI: 10.1080/07357907.2022.2075376] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the clinical characteristics and outcomes of COVID-19 in a large cohort of new cancer patients referred to an oncology clinic in the north of Iran. METHODS During the 20-months COVID-19 pandemic, new cancer patients were followed-up. Demographic, pathologic, and clinical variables were collected for each patient. COVID-19 was confirmed based on a positive polymerase chain reaction test. Analyses were performed using the STATA version 14.0 at a significance level of 0.05. RESULTS In this study, 1294 new cancer patients were followed for 24 months (mean age: 58.7 years [range 10 to 95]). During the study period, COVID-19 was diagnosed in 9.4% of the patients with hospitalization rate of 3.4%, an ICU admission rate of 0.7%, and COVID-19 mortality rate of 4.9%. Hematological malignancies (ORU= 2.6, CI95% 1.28- 5.34), receiving palliative treatments (ORA=3.03, CI95% 1.6-5.45) and receiving radiotherapy (ORA=2.07, 1.17-3.65) were the most common predictive factors of COVID infection in cancer patients. Also, the COVID mortality was higher in brain cancer patients (P = 0.07), metastatic disease (P = 0.01) and patients receiving palliative treatments (P = 0.02). CONCLUSION In patients suffering from cancer, COVID-19 infection can be predicted by cancer type, palliative care, and radiotherapy in cancer patients. Furthermore, brain cancers, metastasis, and palliative care were all associated with COVID-19 related mortality.
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Affiliation(s)
| | - Hamid Fallah Tafti
- Resident of radiation oncology, Babol University of Medical Sciences, Babol, Iran
| | - Yavar Rajabzadeh
- Babolsar Rajaee Cancer Center, Babol University of Medical Sciences, Babol, Iran
| | | | - Nahid Ahmadi
- Cancer Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Davoud Jahansouz
- Babolsar Rajaee Cancer Center, Babol University of Medical Sciences, Babol, Iran
| | - Mohsen Tabasi
- Department of Molecular Biology, Pasteur Institute of Iran, Pasteur Ave., Tehran, 13164, Iran
| | - Seyed Alireza Javadinia
- Vasei Clinical Research Development Unit, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Maryam Joudi
- Assistant professor of Allergy and clinical immunology, Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Hadi Harati
- Assistant professor of Nurology, Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Fahimeh Attarian
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
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4
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Kubelac P, Preda A, Ciuleanu T, Todor N, Balacescu O, Achimas-Cadariu P, Iancu D, Mocan C, Bandi-Vasilica M, Lupse M, Briciu VT, Man MA, Vlad C. Outcomes of patients with cancer infected with SARS-CoV-2: results from the Ion Chiricuță Oncology Institute series. ESMO Open 2022; 7:100423. [PMID: 35279526 PMCID: PMC8828430 DOI: 10.1016/j.esmoop.2022.100423] [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: 01/18/2022] [Accepted: 02/01/2022] [Indexed: 01/08/2023] Open
Abstract
Background The evolution of COVID-19 is a controversial topic in cancer patients. They have been designated by international organizations as a vulnerable population at greater risk for contracting SARS-CoV-2 and having a more severe clinical outcome. Patients and methods Active screening at our institution became routine early in the pandemic. We have examined the clinical data of 341 cancer patients, with a positive RT-PCR SARS-CoV-2 test between April 2020 and February 2021, in the prevaccination era. Results During the infection, 40.5% remained asymptomatic, 27.6% developed a mild form, 20.5% had a moderate form, and 11.4% a severe/critical form of COVID-19 that led to death in 7.6% of cases. Treatment was adapted to disease severity according to national guidelines. In our series, the incidence of COVID-19 infection was lower in cancer patients compared with the general population (P < 0.001), however, the mortality rate was higher in cancer patients in comparison with the general population (7.6% versus 2.9%, P < 0.001). The prognostic factors were assessed by three distinct univariate and multivariate analyses: (i) evolution to a moderate or severe/critical clinical manifestation, (ii) clinical worsening (severe/critical form or death), and (iii) overall survival. In the multivariate analysis, the prognostic factors associated with the evolution to a moderate or severe/critical clinical manifestation were: performance status (PS) (P < 0.0001) and no active treatment in the previous 3 months (P = 0.031). Factors associated with clinical worsening were: PS (P < 0.0001), peripheral arterial disease (P = 0.03), and chronic liver disease (P = 0.04). Factors associated with impaired overall survival were PS (P < 0.0001), ischemic cardiac disease (P = 0.0126), chronic liver disease (P = 0.001), and radiotherapy (P = 0.0027). Conclusion Our series confirms a more severe evolution for COVID-19 infection in cancer patients, with PS as the most prominent prognostic factor in all three multivariate analyses. By active screening, efforts should be in place to keep cancer units as coronavirus-free sanctuaries. This is the first comprehensive study addressing the impact of COVID-19 in a large cohort of cancer patients in Romania. Oncological patients had a higher death rate after COVID-19 infection in comparison with the general population. Decreased PS was the prominent prognostic factor correlated with worse outcomes and death in multiple multivariate analysis.
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5
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Mortality of covid-19 pneumonia during anticancer treatment in lung cancer patients. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp211120018b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim: The COVID-19 pandemic has multiple impacts on the management
of cancer patients. Treatment of malignancies, including chemotherapy,
targeted therapy, immunotherapy and radiotherapy, can suppress the immune
system and lead to the development of severe complications of COVID-19
infection. The aim of this study was to determine the mortality of lung
cancer (LC) patients, in whom the COVID-19 infection was confirmed during
active antitumor treatment. Methods: This retrospective study was conducted
at the Institute for Pulmonary Diseases of Vojvodina. All patients included
in the study underwent active anticancer treatment at the time of diagnosis
of COVID-19. SARS-CoV-2 infection was determined with polymerase chain
reaction test (PCR). Patient data were collected using the institutional
database and observed period was from November 20, 2020 to June 5, 2021.
Statistical analysis of the derived patient?s data using the multivariate
and univariate testing. Results: Out of total 828 observed COVID-19
hospitalized patients 81 were LC patient on active antitumor treatment.
Patients were predominantly male (67.9%), smokers (55.6%), 66.47 years old
(range 43-83). Majority of patients (50.6%) were Eastern Cooperative
Oncology Group performance status (ECOG PS) 1 and 83.9% had at least one
comorbidity. The most common comorbidities were arterial hypertension
(66.7%), chronic obstructive pulmonary disease (COPD) (28.4%) and diabetes
(21%). Obesity, congestive heart failure and other cardiovascular diseases
were present in 11%, 6.2% and 7.4% of patients. The most common was
adenocarcinoma (33.3%), followed by squamous (30.9%) and small-cell lung
cancer (24.7%). Predominantly 63% of the patients were in stage III of
disease and 33.3% were in stage IV. Metastases were most commonly present in
the contralateral lung/pleura (14.8%), brain (6.2%), bone (3.7%) and liver
(3.7%). Systemic anticancer therapy was applied in 37/81 patients (45.6%),
chest radiotherapy in 35/81 (43.2%), concurrent chemoradiotherapy in 1/81
(1.2%) and other types of radiotherapy in 8/81 patients (9.87%). The most
common forms of systemic therapy were chemotherapy (35.8%), immunotherapy
(7.4%) and targeted therapy (2.4%) patients. Most common chemotherapy was
cisplatin-based regiment applied in 34.6% of patients. The mortality from
COVID-19 was 19.8%. The statistically significance in relation to the type
of treatment was not observed (p = 0.973). Statistical significance was
observed between mortality and ECOG PS (p = 0.011). Conclusions: LC patients
are dependent on antitumor treatment and at the same time highly susceptible
to potential infection. In this study we did not find statistically
significant differences in mortality related to the type of antitumor
treatment in COVID-19 positive LC patients. Further detailed research on
larger scale is needed to be performed in order to explore the effects of
SARS-CoV-2 on cancer patients. All possible methods of protection against
SARS-CoV-2 virus should be performed in order to minimize the risk of
infection in all but especially in immunocompromised cancer patients.
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Marks DK, Budhathoki N, Kucharczyk J, Fa’ak F, D’Abreo N, Kwa M, Plasilova M, Dhage S, Soe PP, Becker D, Hindenburg A, Lee J, Winner M, Okpara C, Daly A, Shah D, Ramdhanny A, Meyers M, Oratz R, Speyer J, Novik Y, Schnabel F, Jones SA, Adams S. OUP accepted manuscript. Oncologist 2022; 27:89-96. [PMID: 35641208 PMCID: PMC8895753 DOI: 10.1093/oncolo/oyab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose Provide real-world data regarding the risk for SARS-CoV-2 infection and mortality in breast cancer (BC) patients on active cancer treatment. Methods Clinical data were abstracted from the 3778 BC patients seen at a multisite cancer center in New York between February 1, 2020 and May 1, 2020, including patient demographics, tumor histology, cancer treatment, and SARS-CoV-2 testing results. Incidence of SARS-CoV-2 infection by treatment type (chemotherapy [CT] vs endocrine and/or HER2 directed therapy [E/H]) was compared by Inverse Probability of Treatment Weighting. In those diagnosed with SARS-CoV-2 infection, Mann–Whitney test was used to a assess risk factors for severe disease and mortality. Results Three thousand sixty-two patients met study inclusion criteria with 641 patients tested for SARS-COV-2 by RT-PCR or serology. Overall, 64 patients (2.1%) were diagnosed with SARS-CoV-2 infection by either serology, RT-PCR, or documented clinical diagnosis. Comparing matched patients who received chemotherapy (n = 379) with those who received non-cytotoxic therapies (n = 2343) the incidence of SARS-CoV-2 did not differ between treatment groups (weighted risk; 3.5% CT vs 2.7% E/H, P = .523). Twenty-seven patients (0.9%) expired over follow-up, with 10 deaths attributed to SARS-CoV-2 infection. Chemotherapy was not associated with increased risk for death following SARS-CoV-2 infection (weighted risk; 0.7% CT vs 0.1% E/H, P = .246). Advanced disease (stage IV), age, BMI, and Charlson’s Comorbidity Index score were associated with increased mortality following SARS-CoV-2 infection (P ≤ .05). Conclusion BC treatment, including chemotherapy, can be safely administered in the context of enhanced infectious precautions, and should not be withheld particularly when given for curative intent.
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Affiliation(s)
- Douglas K Marks
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
- Corresponding author: Douglas K. Marks, Department of Medicine, NYU Long Island School of Medicine, 120 Mineola Blvd, Suite 500 Mineola, NY 11501, USA.
| | | | | | - Faisal Fa’ak
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Nina D’Abreo
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Maryann Kwa
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Magdalena Plasilova
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Shubhada Dhage
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Phyu Phyu Soe
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Daniel Becker
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Alexander Hindenburg
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Johanna Lee
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Megan Winner
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY,USA
| | | | - Alison Daly
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Darshi Shah
- NYU Langone Hospital-Long Island, Mineola, NY, USA
| | | | - Marleen Meyers
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Ruth Oratz
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - James Speyer
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Yelena Novik
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Freya Schnabel
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Surgery, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Simon A Jones
- Department of Population Health, NYU Grossman School of Medicine, Manhattan, NY, USA
| | - Sylvia Adams
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, Manhattan, NY, USA
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Bui ATN, Tyan K, Giobbie-Hurder A, Klein IA, Manos MP, Zubiri L, Reynolds K, Grover S, Weinhouse GL, Ott PA, LeBoeuf NR, Rahma O. Impact of COVID-19 on Patients with Cancer Receiving Immune Checkpoint Inhibitors. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2021; 4:35-44. [PMID: 35663537 PMCID: PMC9153254 DOI: 10.36401/jipo-20-34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
Introduction To evaluate the impact of Sars-Cov-2 infection on mortality and immune checkpoint inhibitor (ICI) toxicity in patients with cancer receiving ICIs compared to those not receiving ICIs. Methods We conducted a retrospective matched cohort study of 25 patients receiving ICIs within 1 year of coronavirus disease 2019 (COVID-19) diagnosis between March 20, 2020, and June 3, 2020, at the Dana-Farber Cancer Institute/Mass General Brigham. Cases were matched 1:1 with controls based on age, sex, and anticancer therapy within the prior 6 months. Results Seven of 25 (28%) patients receiving ICIs died from COVID-19 as compared with nine of 25 (36%) controls. Through multivariable analysis adjusting for age, sex, and anticancer therapy, ICI use was not associated with increased risk for COVID-19 death (OR [odds ratio] 0.36, 95% CI 0.07-1.87). Determinants of mortality included age (OR 1.14, 95% CI 1.03-1.27) and chronic obstructive pulmonary disease (OR 12.26, 95% CI 1.76-85.14). Statin use was protective against mortality (OR 0.08, 95% CI 0.01-0.63). Two patients experienced persistent immune-related adverse events (irAEs) (hypophysitis); one had new-onset irAE (hypothyroidism) during their COVID-19 course. Patients with ICIs had significantly higher platelet (p = 0.017) and D-dimer (p = 0.037) levels. Elevated troponin levels (p = 0.01) were associated with COVID-19 death in patients using ICI. Conclusion There is insufficient evidence to conclude COVID-19-related outcomes are associated with ICIs, and we did not observe an increased risk of COVID-19-related death associated with ICIs. The potential protective effect of statin therapy and role of laboratory biomarkers warrant further investigation.
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Affiliation(s)
| | | | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Isaac A. Klein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Whitehead Institute of Biomedical Research, Cambridge, MA, USA
| | - Michael P. Manos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Leyre Zubiri
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Kerry Reynolds
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Shilpa Grover
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA
| | - Gerald L. Weinhouse
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Patrick A. Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicole R. LeBoeuf
- Harvard Medical School, Boston, MA, USA
- Department of Dermatology, Center for Cutaneous Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Osama Rahma
- Harvard Medical School, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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8
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Bora VR, Patel BM. The Deadly Duo of COVID-19 and Cancer! Front Mol Biosci 2021; 8:643004. [PMID: 33912588 PMCID: PMC8072279 DOI: 10.3389/fmolb.2021.643004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022] Open
Abstract
As of September 19, 2020, about 30 million people have been infected with the novel corona virus disease 2019 (COVID-19) globally, and the numbers are increasing at an alarming rate. The disease has a tremendous impact on every aspect of life, but one of the biggest, related to human health and medical sciences, is its effect on cancer. Nearly 2% of the total COVID-19 patients prior to May 2020 had cancer, and the statistics are quite frightening as the patient can be referred to as "doubly unfortunate" to suffer from cancer with the added misery of infection with COVID-19. Data regarding the present situation are scarce, so this review will focus on the deadly duo of COVID-19 and cancer. The focus is on molecular links between COVID-19 and cancer as inflammation, immunity, and the role of angiotensin converting enzyme 2 (ACE2). Complications may arise or severity may increase in cancer patients due to restrictions imposed by respective authorities as an effort to control COVID-19. The impact may vary from patient to patient and factors may include a delay in diagnosis, difficulty managing both cancer therapy and COVID-19 at same time, troubles in routine monitoring of cancer patients, and delays in urgent surgical procedures and patient care. The effect of anti-cancer agents on the condition of cancer patients suffering from COVID-19 and whether these anti-cancer agents can be repurposed for effective COVID-19 treatment are discussed. The review will be helpful in the management of deadly duo of COVID-19 and cancer.
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Affiliation(s)
| | - Bhoomika M. Patel
- Department of Pharmacology, Institute of Pharmacy, Nirma University, Ahmedabad, India
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9
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Isgrò MA, Vitale MG, Celentano E, Nocerino F, Porciello G, Curvietto M, Mallardo D, Montagnese C, Russo L, Zanaletti N, Avallone A, Pensabene M, De Laurentiis M, Centonze S, Pignata S, Cannella L, Morabito A, Caponigro F, Botti G, Masucci GV, Giannarelli D, Cavalcanti E, Ascierto PA. Immunotherapy may protect cancer patients from SARS-CoV-2 infection: a single-center retrospective analysis. J Transl Med 2021; 19:132. [PMID: 33789686 PMCID: PMC8010485 DOI: 10.1186/s12967-021-02798-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 01/22/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) global pandemic has created unique challenges to healthcare systems throughout the world. Ensuring subjects' safety is mandatory especially in oncology, in consideration of cancer patients' particular frailty. We examined the proportion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgM and/or IgG positive subjects in three different groups from Istituto Nazionale Tumori - IRCCS "Fondazione G. Pascale" in Naples (Campania region, Italy): cancer patients treated with Innovative Immunotherapy (Immune Checkpoint Inhibitors, ICIs), cancer patients undergoing standard Chemotherapies (CHTs) and healthcare providers. 9 out of 287 (3.1%) ICIs patients resulted positive, with a significant lower percentage in respect to CHTs patients (39 positive subjects out of 598, 6.5%) (p = 0.04). There was no statistically significant difference between ICIs cohort and healthcare providers, 48 out of 1050 resulting positive (4.6%). Performing a Propensity Score Matching based on gender and tumor stage, the effect of treatment on seropositivity was analyzed through a regression logistic model and the ICIs treatment resulted to be the only protective factor significantly (p = 0.03) associated with positivity (odds ratio-OR: 0.41; 95% confidence interval-CI 0.18-0.91). According to these preliminary data, ICIs would appear to be a protective factor against the onset of COVID-19 infection.
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Affiliation(s)
- Maria Antonietta Isgrò
- Division of Laboratory Medicine, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Maria Grazia Vitale
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Egidio Celentano
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Flavia Nocerino
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Porciello
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Marcello Curvietto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Domenico Mallardo
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Concetta Montagnese
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Luigi Russo
- Division of Laboratory Medicine, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Nicoletta Zanaletti
- Abdominal Oncology Division, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Matilde Pensabene
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Sara Centonze
- Department of Urology and Gynecology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Lucia Cannella
- Department of Muscle-Skeletal Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Alessandro Morabito
- Department of Thoracic Medical Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Francesco Caponigro
- Head and Neck Medical Oncology Unit, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Gerardo Botti
- Scientific Directorate, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Giuseppe Valentino Masucci
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Centrum Karolinska, 171 76 Stockholm, Sweden
| | - Diana Giannarelli
- Biostatistic Unit, Istituto Nazionale Tumori Regina Elena, IRCCS, Rome, Italy
| | - Ernesta Cavalcanti
- Division of Laboratory Medicine, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
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10
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Ferrua M, Mathivon D, Duflot-Boukobza A, Abbas M, Charles C, Barrais A, Legendre J, Mendes C, Pons M, Merad M, Minvielle E, Mir O, Scotté F. Nurse navigators' telemonitoring for cancer patients with COVID-19: a French case study. Support Care Cancer 2021; 29:4485-4492. [PMID: 33462724 PMCID: PMC7813165 DOI: 10.1007/s00520-020-05968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/22/2020] [Indexed: 02/08/2023]
Abstract
Purpose The Gustave Roussy Cancer Institute implemented a patient-reported outcome platform (CAPRI-COVID) for cancer patients with coronavirus disease 2019 (COVID-19) to quarantine patients at home while ensuring monitoring of COVID-related symptoms and securing the care pathway. In this study, we described the CAPRI-COVID intervention, evaluated its use, and presented results of the tracking indicators with a focus on the nurse navigators’ (NNs) activities and the experience of patients. Methods Data of 130 cancer patients with COVID-19 diagnosed from March 23 to June 5, 2020, were collected. Six COVID-related symptoms were monitored daily, either by the patient via the CAPRI mobile application (CAPRI App) or by NNs via telemonitoring. In the cases of worsening or new-onset symptoms, an automated alert was sent to the platform, and NNs could immediately consult an emergency physician for future course of action. Results All 130 patients (median age: 59 years; 59.2% female) were monitored during the study period. There were no deaths or admissions to the intensive care unit attributable to COVID-19; 7.8% of patients were hospitalized (excluding scheduled hospitalization), and 17.1% were admitted to the emergency department at least once during the monitoring period. NNs carried out 1412 regular monitoring calls (average of 10.9 calls per patient), while 55% of the patients downloaded the CAPRI App. Conclusions Most patients monitored with CAPRI-COVID were quarantined during the first wave of the pandemic. In addition to the CAPRI App, which helped limit phone calls, NNs played an essential role in patient management.
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Affiliation(s)
- Marie Ferrua
- Research Department, Gustave Roussy, Villejuif, France.
| | - Delphine Mathivon
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | | | - May Abbas
- Interdisciplinary Cancer Pathways Division (DIOPP), Gustave Roussy, Villejuif, France
| | - Cécile Charles
- Interdisciplinary Cancer Pathways Division (DIOPP), Gustave Roussy, Villejuif, France.,Laboratory of Psychopathology and Health Processes (EA 4057), University of Paris Descartes, Sorbonne, Paris, France
| | - Amandine Barrais
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Jennifer Legendre
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Christine Mendes
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Magali Pons
- Interdisciplinary Cancer Pathways Division (DIOPP), Gustave Roussy, Villejuif, France
| | | | | | - Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Florian Scotté
- Interdisciplinary Cancer Pathways Division (DIOPP), Gustave Roussy, Villejuif, France
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11
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de Las Heras B, Saini KS, Boyle F, Ades F, de Azambuja E, Bozovic-Spasojevic I, Romano M, Capelan M, Prasad R, Pattu P, Massard C, Portera C, Saini ML, Singh BP, Venkitaraman R, McNally R, Leone M, Grande E, Gupta S. Cancer Treatment and Research During the COVID-19 Pandemic: Experience of the First 6 Months. Oncol Ther 2020; 8:171-182. [PMID: 32749634 PMCID: PMC7402077 DOI: 10.1007/s40487-020-00124-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has had a significant impact on patients with underlying malignancy. In this article, we summarize emerging data related to patients with cancer and COVID-19. Among patients with COVID-19, a higher proportion have an underlying diagnosis of cancer than seen in the general population. Also, patients with malignancy are likely to be more vulnerable than the general population to contracting COVID-19. Mortality is significantly higher in patients with both cancer and COVID-19 compared with the overall COVID-19-positive population. The early months of the pandemic saw a decrease in cancer screening and diagnosis, as well as postponement of standard treatments, which could lead to excess deaths from cancer in the future.
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Affiliation(s)
- Begoña de Las Heras
- Covance Inc., Princeton, NJ, USA
- Madrid Medical Doctors Association, Madrid, Spain
| | - Kamal S Saini
- Covance Inc., Princeton, NJ, USA.
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK.
| | | | - Felipe Ades
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Evandro de Azambuja
- Institut Jules Bordet, Brussels, Belgium
- Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | | | | | | | - Rajeev Prasad
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | | | | | | | | | | | | | | | | | | | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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12
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Development of a Patient-Centered Framework for Oncology Clinicians to Address Uncertainty in Cancer Care During the COVID-19 Pandemic. Curr Treat Options Oncol 2020; 21:99. [PMID: 33119833 PMCID: PMC7594962 DOI: 10.1007/s11864-020-00795-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 01/26/2023]
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13
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Curigliano G, Banerjee S, Cervantes A, Garassino MC, Garrido P, Girard N, Haanen J, Jordan K, Lordick F, Machiels JP, Michielin O, Peters S, Tabernero J, Douillard JY, Pentheroudakis G. Managing cancer patients during the COVID-19 pandemic: an ESMO multidisciplinary expert consensus. Ann Oncol 2020; 31:1320-1335. [PMID: 32745693 PMCID: PMC7836806 DOI: 10.1016/j.annonc.2020.07.010] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 12/14/2022] Open
Abstract
We established an international consortium to review and discuss relevant clinical evidence in order to develop expert consensus statements related to cancer management during the severe acute respiratory syndrome coronavirus 2-related disease (COVID-19) pandemic. The steering committee prepared 10 working packages addressing significant clinical questions from diagnosis to surgery. During a virtual consensus meeting of 62 global experts and one patient advocate, led by the European Society for Medical Oncology, statements were discussed, amended and voted upon. When consensus could not be reached, the panel revised statements until a consensus was reached. Overall, the expert panel agreed on 28 consensus statements that can be used to overcome many of the clinical and technical areas of uncertainty ranging from diagnosis to therapeutic planning and treatment during the COVID-19 pandemic.
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Affiliation(s)
- G Curigliano
- Department of Oncology and Hemato-Oncology, Division of Early Drug Development, European Institute of Oncology, IRCCS and University of Milano, Milan, Italy.
| | - S Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - A Cervantes
- Department of Medical Oncology, Biomedical Research Institute, INCLIVA, University of Valencia, Valencia, Spain; Hematology and Medical Oncology, CIBERONC Instituto de Salud Carlos III, Madrid, Spain
| | - M C Garassino
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - P Garrido
- Medical Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - N Girard
- Thoracic Oncology, Université de Lyon, Université Claude Bernard Lyon, Lyon, France; Thoracic Surgery, Département Oncologie Médicale, Institut Curie, Paris, France
| | - J Haanen
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - F Lordick
- Department of Institut Roi Albert II, University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - J P Machiels
- Institut Roi Albert II, Service d'Oncologie Médicale, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (POLE MIRO), Université Catholique de Louvain, Brussels, Belgium
| | - O Michielin
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - S Peters
- Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Y Douillard
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - G Pentheroudakis
- Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Epirus, Greece
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14
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Bersanelli M, Zielli T, Perrone F, Casartelli C, Pratticò F, Rapacchi E, Camisa R, Tognetto M, Clemente A, Giannarelli D, Rebuzzi SE, Leonetti A, Bordi P, Tiseo M, Buti S. Clinical impact of COVID-19 in a single-center cohort of a prospective study in cancer patients receiving immunotherapy. Immunotherapy 2020; 12:1139-1148. [PMID: 32933369 PMCID: PMC7493722 DOI: 10.2217/imt-2020-0211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Evaluating the incidence and course of COVID-19 in cancer patients treated with immunotherapy. Patients & methods: We reported the influenza-like illness events with diagnosis of COVID-19 within the patient cohort enrolled in the prospective observational multicenter INVIDIa-2 study in the single center of Parma. Results: Among 53 patients, eight experienced influenza-like illness during the influenza season 2019/2020, and three of them had diagnosis of COVID-19. They were males, elderly, with cardiovascular disease. Radiological features of COVID-19 pneumonitis were found in all of three cases, although the pharyngeal swab resulted positive in only two. Two of these three patients died due to respiratory failure. Conclusion: Cancer patients are at high risk of severe events from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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Affiliation(s)
- Melissa Bersanelli
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy.,Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Teresa Zielli
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | | | - Fabiana Pratticò
- Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | - Roberta Camisa
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | | | - Alberto Clemente
- Biostatistics & Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014, Meldola, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, 00144, Rome, Italy
| | | | - Alessandro Leonetti
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy.,Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
| | - Marcello Tiseo
- Medicine & Surgery Department, University of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University of Parma, 43126, Parma, Italy
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15
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SARS-CoV-2 and cancer: Are they really partners in crime? Cancer Treat Rev 2020; 89:102068. [PMID: 32731090 PMCID: PMC7351667 DOI: 10.1016/j.ctrv.2020.102068] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/15/2022]
Abstract
The outbreak of the SARS-CoV-2 pandemic has overwhelmed health care systems in many countries. The clinical presentation of the SARS-CoV-2 varies between a subclinical or flu-like syndrome to that of severe pneumonia with multi-organ failure and death. Initial reports have suggested that cancer patients may have a higher susceptibility to get infected by the SARS-CoV-2 virus but current evidence remains poor as it is biased by important confounders. Patients with ongoing or recent cancer treatment for advanced active disease, metastatic solid tumors and hematological malignancies are at higher risk of developing severe COVID-19 respiratory disease that requires hospitalization and have a poorer disease outcome compared to individuals without cancer. However it is not clear whether these are independent risk factors, or mainly driven by male gender, age, obesity, performance status, uncontrolled diabetes, cardiovascular disease and various other medical conditions. These often have a greater influence on the probability to die due to SARS-CoV-2 then cancer. Delayed diagnosis and suboptimal cancer management due to the pandemic results in disease upstaging and has considerable impact cancer on specific death rates. Surgery during the peak of the pandemic seems to increase mortality, but there is no convincing evidence that adjuvant systemic cancer therapy and radiotherapy are contraindicated, implicating that cancer treatment can be provided safely after individual risk/benefit assessment and some adaptive measures. Underlying immunosuppression, elevated cytokine levels, altered expression of the angiotensin converting enzyme (ACE-2) and TMPRSS2, and a prothrombotic status may fuel the effects of a SARS-CoV-2 in some cancer patients, but have the potential to be used as biomarkers for severe disease and therapeutic targets. The rapidly expanding literature on COVID-19 should be interpreted with care as it is often hampered by methodological and statistical flaws.
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16
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Addeo A, Friedlaender A. Cancer and COVID-19: Unmasking their ties. Cancer Treat Rev 2020; 88:102041. [PMID: 32516704 PMCID: PMC7831797 DOI: 10.1016/j.ctrv.2020.102041] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) and its clinical manifestation, the coronavirus disease 2019 (COVID19) have rapidly spread across the globe, leading to the declaration of a pandemic. While most present mild symptoms, it appears as though nearly 20% of confirmed patients develop significant complications. These include acute respiratory distress syndrome, septic shock and multi-organ failure, with a 3-6% mortality. A plethora of treatments has been or is being assessed, but to date, none has been proven effective. Management is mainly symptomatic, with organ support for the critically ill. Several reports, mainly case series, from across the world have concluded that patients with malignancy appear more susceptible to severe infection and mortality from COVID-19. This could be attributed to immunosuppression, co-existing medical conditions and underlying pulmonary compromise which is often the case in lung malignancy. Patients with haematological cancer and those who are receiving active chemotherapy treatment may be at greatest risk due to increased immunosuppression. This pandemic tested the resilience of worldwide health-care systems in an unprecedented manner. It has forced oncologists to rethink the entire diagnostic and therapeutic process, based on the local prevalence and impact of COVID-19. In this review we will discuss the impact of COVID-19 on patients affected by cancer, their diagnosis and management, as well as the pathophysiology of COVID-19 induced acute respiratory distress symptoms and currently investigated treatment approaches.
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Affiliation(s)
- A Addeo
- Oncology Department, University Hospital of Geneva, Switzerland.
| | - A Friedlaender
- Oncology Department, University Hospital of Geneva, Switzerland
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17
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