Impact of vaccination against COVID-19 on patients with cancer in ACHOC-C19 study: Real world evidence from one Latin American country

Introduction: During the pandemic, it has been recommended that vaccination against COVID-19 be a priority for patients with cancer; however, these patients were not included in the initial studies evaluating the available vaccines. Objective: To define the impact of vaccination against COVID-19 in preventing the risk of complications associated with the infection in a cohort of patients with cancer in Colombia. Methods: An analytical observational cohort study, based on national registry of patients with cancer and COVID 19 infection ACHOC-C19, was done. The data was collected from June 2021, until October 2021. Inclusion criteria were: Patients older than 18 years with cancer diagnosis and confirmed COVID-19 infection. Data from the unvaccinated and vaccinated cohorts were compared. Outcomes evaluated included all-cause mortality within 30 days of COVID-19 diagnosis, hospitalization, and need for mechanical ventilation. The estimation of the effect was made through the relative risk (RR), the absolute risk reduction (ARR) and the number needed to treat (NNT). Multivariate analysis was performed using generalized linear models. Results: 896 patients were included, of whom 470 were older than 60 years (52.4%) and 59% were women (n=530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of clinical outcomes among the unvaccinated vs vaccinated patients were: for hospitalization 42% (95% CI: 38.7%-46.1%) vs 29%; (95% CI: 22.4%-36.5%); for invasive mechanical ventilation requirement 8.4% (n=61) vs 4.6% (n=8) and for mortality from all causes 17% (n=123) vs 4.65% (n=8). Conclusion: In our population, unvaccinated patients with cancer have an increased risk of complications for COVID -19 infection, as hospitalization, mechanical ventilation, and mortality. It is highly recommended to actively promote the vaccination among this population.

Abstract P4-06-03: Pathological complete response (ypCR) in early and locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy in a middle-income country. Results from a real-world historical cohort

Introduction Breast cancer (BC) is the most frequent neoplasm in Colombia, with mortality rate increasing in past decade. The expected 5-year overall survival (OS) is < 80%, being the Latin American country with the worst prognosis. 2 factors related to this are higher frequency of advanced stages and higher frequency of aggressive tumor subtypes.Neoadjuvant chemotherapy (NACT), and ypCR, have demonstrated impact on the risk of relapse and death. This trial describes the characteristics, treatment patterns, clinical outcomes, and ypCR after NACT in a cohort of Colombian BC patients.

Methods We included BC adult patients treated with NACT in 3 institutions in Colombia. Clinical, sociodemographic, and outcome variables were retrieved retrospectively from clinical charts. Univariate, bivariate and time-to-event analyses were performed. A partition survival tree was performed to explore interactions between variables. Statistical analyses were done in R software.The protocol was approved by the IRC and EC of Fundación Cardioinfantil and Hospital Militar Central.

Results We included 312 patients treated between 2013 and 2019. 50.9% were ER and/or PgR positive, 28.5% HER2 positive and 20.5% triple negative breast cancer (TNBC). 75.9% of the patients had a LABC. TNBC patients were younger (median age 46 years), premenopausal (58%), had higher Ki67 index (Ki67 ≥ 20%= 91%), and a higher tumor grade (Grade 3= 56.7%). Most of the patients (91.7%), received Doxorubicin + Cyclophosphamide, and Taxanes (97.8%), 76.6% of TNBC patients received Carboplatin. Breast conserving surgery was performed in 53.7% of the patients, and only 38.9% received immediate breast reconstruction. 88.5% of the patients were treated with adjuvant radiotherapy. The ypCR rate was 34.6% and was achieved more frequently in HER2 positive subtype. The ypCR rates in TBNC were higher in patients treated with carboplatin (55% vs 20%, p=0.02). Other factors related to ypCR were high Ki67 (p= 0.0005) and higher tumor grade (p= 0.0034). Most of the relapses were distant (14.1%), with only 1.9% of local relapse rate. Table No 1 summarizes clinical outcomes. With a median follow up of 4.9 years, the 5 year OS was 88.2%. Clinical stage at diagnosis (p= 0.01); node involvement (p= 0.0014); ER (p= 0.0032); PgR (p= 0.0069); HER2 (p= 0.0334); phenotype (p=0.0145); type of surgery (p< 0.0001); ypCR (p=0.003); and relapse (p= < 0.00001) were related with OS. We did not found differences in the 5 year OS between stage II and III patients (87.8% vs 88%). The 5 year OS did not differ between ypCR and ypCR-IS (94.2% vs 93%). The relapse rate was 3.7% in ypCR vs 22.1% in non ypCR patients (p< 0.00001). The 5 year OS rate was 94.3% for ypCR and 85% for non ypCR patients (p= 0.0059). When analyzed by phenotype, ypCR was only related to risk of death among TNBC (p= 0.011). We perform a partition survival tree, identifying 6 subgroups with different OS behaviors: TNBC and non TBNC; low proliferative and high proliferative; early stage and locally advanced stage.

Discussion We found an increased number of LABC. The ypCR rate was higher than described elsewhere, explained by higher proportion of TNBC and HER2 enriched tumors and differences in treatment selection in subgroups. In the TNBC subgroup the use of carboplatin was associated with higher ypCR. ypCR was related with risk of death and relapse, but with statistical significance for OS only in the TNBC population. This study offers a baseline characteristic of NACT BC cohort, that will allow us to design and implement strategies to improve outcomes in early and LABC.

Table 1: Treatment outcomes by phenotype.

Citation Format: William Mantilla, Maria-Fernanda Gonzalez, Sebastian Rojas, Mariana Borras-Osorio, Nicolas Molano-Gonzalez, Joaquin Guerra, Isabel Munevar, Diego Moran. Pathological complete response (ypCR) in early and locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy in a middle-income country. Results from a real-world historical cohort. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-03.

Real-world evidence of nivolumab for non-small-cell lung cancer in a developing country

Nivolumab is a human programmed death receptor-1 blocking antibody, used as treatment option in patients with advanced non-small-cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second-line (2L) or third-line (3L) therapy in patients with advanced NSCLC. This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as 2L or 3L treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) to treatment. OS and PFS were estimated with the Kaplan-Meier method and the differences were evaluated through the log-rank test. Data of 178 patients were included. The median follow-up was 26.8 months (interquartile range (IQR): 20.3-40.4). Nivolumab was commonly used as a 2L treatment (77.5%). The outcomes in this setting (2L) were as follows: ORR was 21.0%, and the median PFS and OS were 5.5 months (95% confidence interval (CI): 4.5-6.5) and 12.4 months (95% CI: 10.8-14.0), respectively. In 3L, the ORR with nivolumab was 15.0%, the median PFS and OS were 4.1 months (95% CI: 3.1-5.1) and 10.1 months (95% CI: 9.4-10.6), respectively. Three patients (1.7%) required discontinuation due to toxicity. Nivolumab effectiveness and safety in this scenario was consistent with that reported by previous trials and other real-world data.

Prognostic factors for recurrence and mortality in patients with localized malignant melanoma: Analysis of the Epidemiological Registry of Malignant Melanoma in Colombia REMMEC ACHO

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Background: Malignant melanoma is the skin cancer with the highest mortality rate. In early stages, it may have a better prognosis and some possibility of cure. In Colombia, given the increase in cases, a national registry of the disease has been initiated with the aim of characterizing the population and establishing the prognostic factors in the local context. Methods: Cohort study based on data from the Epidemiological Registry of Malignant Melanoma in Colombia (REMMEC). For this first phase,data from January 2011 to December 2021 were analyzed. Patients were older than 18 years, with confirmed diagnosis of localized melanoma. Mortality and recurrence incidence rates were calculated using the Kaplan-Meier method, overall survival was estimated at 5 years of follow-up for each stage. Finally, a prognostic model was made for the mortality outcome, using the Cox proportional hazards method. Results: 759 patients were included, the mean age was 66 years (SD: 15.6), 57% women (n = 431), 29% phototype I or II (n = 219), and the most frequent histological subtype was acral lentiginous (n = 211; 36%). In relation to the stage, 13.9% with stage 0 (n = 106), 24.2% in stage I (n = 184), 30% in stage II (n = 228), and 31.7% in stage III (n = 241). ECOG-3-4 in 1.05% (n = 8). Regarding the health regimen, the subsidized patients were 199 (26%), and the contributive 560 (73.8%), of which 35 and 30.6% had stage III, respectively. 92% of all patients underwent local surgery (n = 699) and 30% (n = 226) local lymphadenectomy. The median follow-up time was 36 months (IQR: 17-72). The mortality incidence rate was 3.6 cases per 100 person-years (95% CI: 2.9-4.3), and the recurrence rate was 6.8 cases per 100 person-years (95% CI: 5.9 -7.8). Overall survival at five years for patients in stage 0 and I was 97% (95% CI: 89-99), for stage II it was 80% (95% CI: 72.6-86.6); for stage III 65% (95% CI: 57-72). 22.4% (n = 170) received adjuvant treatment . 26.2% (n = 199) had metastatic recurrence. The prognostic factors for mortality are presented in Table. Conclusions: In the Colombian context, in patients with localized melanoma, ECOG 3 or 4, stage III at the time of diagnosis, receiving radiotherapy, the presence of ulceration, chronic sun exposure, and the subsidized health regimen are poor prognostic factors.[Table: see text]

Effectiveness of COVID -19 vaccine on cancer patients in one Latin American country: A follow-up of ACHOC-C19 study

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Background: In our experience during the first year of development of ACHOC-C19 study, we observed 26% mortality in patients with cancer and COVID 19 infection. The impact of vaccination was not evaluated prior to the implementation of this strategy worldwide in this kind of population. It was proposed to evaluate the effectiveness of immunization during the second phase of our investigation. Methods: Cohort study derived from the National Registry of Patients with Cancer and COVID-19 (ACHOCC-19). Data were collected from June 2021 since vaccine was available. Patients were: older than 18 years, diagnosed with cancer (solid tumors), treated and/or under follow-up, and with COVID-19 infection. The comparative analysis of the vaccinated and non-vaccinated cohort is presented. Outcomes included: all-cause mortality within 30 days of infection diagnosis, hospitalization, and mechanical ventilation. Effect estimation was performed through relative risk (RR) and multivariate analysis for each event, using generalized linear models of the binomial family. Results: 896 patients were included, 470 were older than 60 years (52.4%) and 59% women (n = 530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of hospitalization among the unvaccinated was 42.4% (n = 307), and among the vaccinated, 29% (n = 50); invasive mechanical ventilation requirement was 8.4% (n = 61) in unvaccinated, and 4.6% (n = 8) in vaccinated. The cumulative incidence of mortality from all causes in the unvaccinated was 17% (n = 123) and in the vaccinated 4.65% (n = 8). Table summarizes the multivariate analysis. The adjusted RR for mortality for the unvaccinated is 3.4 (95% CI: 1.7-6.8), for hospitalization 1.36 (95% CI: 1.08-1.72), and for mechanical ventilation 2.1 (95% CI: 1.02-4.2). Conclusions: The incidence of complications and death in patients with cancer and COVID-19 infection is significantly higher in those who have not received a vaccination schedule compared to those who have been vaccinated. Immunization should be promoted and intensified in this population group.[Table: see text]

Real-World Evidence of Epidemiology and Clinical Outcomes in Multiple Myeloma, Findings from the Registry of Hemato-Oncologic Malignancies in Colombia, Observational Study

INTRODUCTION/BACKGROUND

Multiple Myeloma (MM) is a plasma cell derived clonal disorder that represents around 1% of all newly diagnosed neoplasms. Limited data regarding MM treatment in Latin America is available, and access to novel agents for a substantial portion of the population is limited by their high costs.

MATERIALS (OR PATIENTS) AND METHODS

RENEHOC is a bidirectional (retrospective and prospective) multicenter observational registry of hematological malignancies in Colombia. MM patients included up to July 2020 were analyzed on this report.

RESULTS

890 are reported with a median follow-up of 18 months (IQR: 7-42 months). Patients were classified by age group (≤ or > 65 years). Median age at diagnosis was 67 years (IQR: 59-75 years) and 47.1% of patients were women. 709 patients (79.6%) received Bortezomib-based schemes as part of the first line. Two hundred and fifty-two patients (28.3%) were consolidated with Autologous Stem Cell Transplantation (ASCT) in first-line. ASCT consolidation and age were the main independent factors influencing outcomes; in the non-ASCT cohort, 5-year overall survival was 48.7% (CI 41.8-55.2) compared to 80.7% (CI 73-86.4) in ASCT patients.

CONCLUSION

This data depicts the reality of MM in Colombia, which likely reflects other Latin American countries, where access barriers to diagnosis and treatment are echoed in advanced stage diagnosis and a low rate of transplants. These seem to negatively impact survival despite the availability of most novel drugs approved for this disease. Thus, emphasizing the paradox that prevails in most of the region: availability without equitable access.

Immunotherapy in Hispanic patients with advanced non-small cell lung cancer: A real-world data

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Background: Nivolumab is a human programmed death receptor-1 (PD-1) blocking antibody, used as treatment option in patients with advanced non-small cell lung cancer (NSCLC). We assessed the nivolumab efficacy in terms of survival and response to treatment as second- or third-line therapy in patients with advanced NSCLC. Methods: This is a multicentric observational study. Data of patients with advanced NSCLC who received nivolumab as second (2L) or third-line (3L) treatment were analyzed retrospectively. Information regarding patient demographics and clinical backgrounds, treatment patterns from diagnosis to post-nivolumab treatment, effectiveness, and safety of nivolumab treatment were collected. The outcomes evaluated were overall survival (OS), progression-free survival (PFS), and objective reponse rate to treatment (ORR). OS and PFS were estimated with the Kaplan-Meier method. Statistical analysis was carried out using SPSS version 21.0. Results: Eleven centers distributed across the country (Colombia) participated. Data from 178 patients were included. The median follow-up was 26.8 months (IQR 20.3 - 40.4). Women represented 51.7% of the population, and the median age was 63 years (IQR 56-72 years). Nivolumab was commonly used as a 2L treatment. The ORR with nivolumab as 2L treatment was 21.0%. The median PFS and OS were 5.5 months (95%CI: 4.5 – 6.5) and 12.4 months (95%CI: 10.8 – 14.0), respectively. In 3L the ORR with nivolumab was 15.0%. The overall incidence of adverse events was 1.7%. Conclusions: Nivolumab effectiveness and safety in this scenario was consistent with than reported by previous trials and other real world data.

Impact of COVID-19 Infection on Patients with Cancer: Experience in a Latin American Country: The ACHOCC-19 Study

INTRODUCTION

The ACHOCC-19 study was performed to characterize COVID-19 infection in a Colombian oncological population.

METHODOLOGY

Analytical cohort study of patients with cancer and COVID-19 infection in Colombia. From April 1 to October 31, 2020. Demographic and clinical variables related to cancer and COVID-19 infection were collected. The primary outcome was 30-day mortality from all causes. The association between the outcome and the prognostic variables was analyzed using logistic regression models and survival analysis with Cox regression.

RESULTS

The study included 742 patients; 72% were >51 years. The most prevalent neoplasms were breast (132, 17.77%), colorectal (92, 12.34%), and prostate (81, 10.9%). Two hundred twenty (29.6%) patients were asymptomatic and 96 (26.3%) died. In the bivariate descriptive analysis, higher mortality occurred in patients who were >70 years, patients with lung cancer, ≥2 comorbidities, former smokers, receiving antibiotics, corticosteroids, and anticoagulants, residents of rural areas, low socioeconomic status, and increased acute-phase reactants. In the logistic regression analysis, higher mortality was associated with Eastern Cooperative Oncology Group performance status (ECOG PS) 3 (odds ratio [OR] 28.67; 95% confidence interval [CI], 8.2-99.6); ECOG PS 4 (OR 20.89; 95% CI, 3.36-129.7); two complications from COVID-19 (OR 5.3; 95% CI, 1.50-18.1); and cancer in progression (OR 2.08; 95% CI, 1.01-4.27). In the Cox regression analysis, the statistically significant hazard ratios (HR) were metastatic disease (HR 1.58; 95% CI, 1.16-2.16), cancer in progression (HR 1.08; 95% CI, 1.24-2.61) cancer in partial response (HR 0.31; 95% CI, 0.11-0.88), use of steroids (HR 1.44; 95% CI, 1.01-2.06), and use of antibiotics (HR 2.11; 95% CI, 1.47-2.95).

CONCLUSION

In our study, patients with cancer have higher mortality due to COVID-19 infection if they have active cancer, metastatic or progressive cancer, ECOG PS >2, and low socioeconomic status.

IMPLICATIONS FOR PRACTICE

This study's findings raise the need to carefully evaluate patients with metastatic cancer, in progression, and with impaired Eastern Cooperative Oncology Group status to define the relevance of cancer treatment during the pandemic, consider the risk/benefit of the interventions, and establish clear and complete communication with the patients and their families about the risk of complications. There is also the importance of offering additional support to patients with low income and residence in rural areas so that they can have more support during cancer treatment.

Description of asymptomatic cancer patients with COVID-19 infection: Experience of the ACHOCC-19 study in one Latin American country

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Background: Cancer has been described as a risk factor for worse prognosis in people with Covid-19. However, there are few studies informing on the characteristics of cancer patients that have asymptomatic SARS-cov2 infection. The ACHOCC-19 study included asymptomatic patients. Methods: Analytical cohort study of patients with cancer and SARS-cov2 infection in Colombia. From April 1 to October 31, 2020, we collected data on demographic and clinical variables related to cancer and COVID-19 infection. We describe the characteristics and outcomes of patients who had no symptoms of COVID19. Association between outcomes and prognostic variables was analyzed using logistic regression models. Results: We included 742 patients, of which 205 (27.6%) were asymptomatic. Of these 62.2% were older than 61 years, 66% were women, 1.42% were smokers. The most frequent malignancy was breast cancer (25%), followed by colon-rectum (14.6%), sarcoma/soft tissues (5.66%) and lung cancer (5.19%). Patients were more likely to be asymptomatic if they had fewer comorbidities (0-1 comorbidities: 84% asymptomatic, 2 comorbidities: 10.85%, more than 2 comorbidities: 5.15%). 90.5% lived in urban areas and 53.37% had low income. 35.4% of patients had metastatic disease, 8.7% had progressive cancer, 40% had stable disease or partial response. No patient had an ECOG PS of 4 or more, and only 1.91% had ECOG 3. In logistic regression analysis statistically significant associations for having symptomatic disease included: man, presence of 1, 2 or > 2 comorbidities, ECOG 1,2 or 3 and cancer in progression. On the other hand, the statistically significant ORs for having asymptomatic disease were age between 18 and 30 years old, cancer in remission and receiving non-cytotoxic treatment. Table sumarizes ORs and their respective 95% CIs of the variables adjusted in the logistic regression model. Conclusions: In our stumdy, cancer patients had a higher probability of asymptomatic COVID-19 infection if they were women, between the ages of 18 and 30 years, had cancer in remission , ECOG 0 and no comorbidities. This is the first cohort of patients with cancer and asymptomatic covid 19 with a significant sample size in Latin America.[Table: see text]