|(Image from: AACR)|
On the first day, the 27th, there were mainly presentations on current or completed bio-clinical trials. On the 28th, the meeting was started with the plenary session on the subject of <COVID-19 and Cancer>, followed by symposiums and general meetings on new drugs and treatments under development.
The virtual plenary session <COVID-19 and Cancer>, which was held at 9 AM EDT, consisted of 7 presentations. In each presentation, the status of COVID-19 and various statistics on cancer patients in major countries and cities around the world, such as Wuhan, Milan, Paris, Madrid, Naples, and New York, were revealed, and their views and opinions were also shared.
The following are the six presentations presented after Prof. Li Zhang of Tongji Medical College in the first order, <The experience of treating patients with cancer during the COVID-19 pandemic in China>.
TERAVOLT researched 200 patients with COVID-19 and thoracic cancers from 8 countries. As a feature of the findings, the mortality rate was 34.6%, and most of the deaths were due to COVID-19, not cancer. The most frequent complications were pneumonia and acute respiratory distress syndrome (ARDS), and she emphasized that many patients were not offered of ICU admissions mainly due to the shortages and institutional rules.
“Tumor type and cancer therapy did not impact survival. Even at multivariate analysis, no factors were associated with risk of death. As the cancer diagnosis patients with thoracic malignancies are less likely to be admitted to the intensive care unit, they are at increased risk of prolonged hospitalization and mortality from COVID-19 infection,” Garassino stated.
“Our study has several limitations such as short follow-up and selected population, but TERAVOLT will continue to collect data and to provide data in order to identify characteristics associated to a severe COVID-19 able to help societies to create guidelines tailored on individual risk.”
The research in this presentation was conducted on a total of 7,251 cancer patients managed by Gustave Roussy from March 14 to April 15. As of April 20, 95 (69.3%), 20 (14.6%), and 22 (16.1%) pts were discharged, had died, or were still hospitalized, respectively. Moreover, clinical deterioration occurred in 34 (24.8%) who were associated with hematological underlying disease, CRP at diagnosis of COVID19 or the use of cytotoxic chemotherapy.
“Globally, the rate of the SARS-CoV-2 infection in our cancer patients’ population does not seem to be higher compared to the global population. We have not found evidence that COVID19 is more lethal or aggressive in cancer patients that underwent usual SARS-Cov-2 treatment,” Barlesi stated.
“Special attention has to be given to frail patients with ECOG>1, hematological diseases, or advanced disease treated with cytotoxic chemotherapy within the last 3 months. We believe that adequate testing and protective measures will justify an optimal management of the cancer patients’ underlying tumor.”
From March 9 to April 19, a total of 287 cancer patients were screened, and approximately 26% were confirmed. Data on the first 63 patients were shared through the presentation. More than 80% of patients had metastatic diseases, and 40% had lung-related cancer. The mortality rate was about 25% (16), and lung-related cancer, neutropenia, and acute respiratory distress syndrome were the major risk factors. It was also noted that positive results such as 9 out of 15 patients survived as a result of using the Tocilizumab treatment.
“For all patients admitted routine blood test and Chest Xr or CT of the lungs performed previously to been transferred to Ward. Specifics and separate wards for suspected, confirmed and negative coronavirus patients were prepared. Also, all chemo Treatments were reconsidered based on objectives, life expectancy, and type of therapy and clinical status of every patient,” stated Gomez-Martin.
“COVID-19 treatment must be multidisciplinary and it should include specific antiviral therapy, supportive treatment, close monitoring of inflammatory parameters, and appropriate use of anticoagulants given the risk of thromboembolic complications in this disease.”
In the institution to which Ascierto belongs, only two out of 400 patients were confirmed as COVID-19, and all succeeded in receiving a negative test within 10 days using Tocilizumab therapy. Tocilizumab is an anti-IL-6 drug and is known to be effective in patients with cytokine release syndrome. It was also explained that the COVID-19 related acute respiratory stress syndrome is caused by excessive cytokine production.
“To keep safe both patients and healthy workers is the most important rule. In our daily practice we adopted a specific policy about the conduct of our clinical managements of melanoma patients, in order to minimize the risk of any potential exposure. We are prioritizing patients, according to the kind of treatment and the stage of disease,” stated Ascierto.
“In Italy we started on 19th of March a phase II study (NCT04317092) which enrolled 330 patients in 24 hours, with the ability of tocilizumab to reduce the one-month mortality rate as main endpoint. Besides, we are also conducting clinical study on another anti-IL-6 drug, Sarilumab.”
He first introduced the status of COVID-19 impact on New York State. As of April 22, when fatality was categorized as race/ethnicity, Hispanic (34%) and Black (28%) patients more than 60%. Out of 15,740, the total number of deaths, 14,018 had at least one comorbidity. Hypertension (9,028) was the highest, and the cancer was 1,154.
“The proportion of Black and Hispanic was also high in non-hospitalized, non-fatal hospitalized cases, compared to White and Asians. Higher incidence of cancer, higher cancer-related mortality, higher incidence of COVID-19, and higher COVID-19 were related mortality in African American population. But we need to be more careful, because the reality is more complex. We need more time and data,” Voigt stated.
“Pandemic create perfect conditions for suboptimal care or deviation from standard care with major impact on the most vulnerable patients. This is because healthcare systems become overwhelmed during pandemic, and decisions are sometimes driven by fear and emotions rather than evolving facts. The most vulnerable among us can fall out of the safety net if we do not pay attention. We need to create more robust safety net.”
Zhongnan Hospital conducted a multi-center study including 105 cancer patients and 536 age-matched non-cancer patients confirmed with COVID-19. According to the study, COVID-19 patients with cancer had higher risks in all severe outcomes. Patients with hematological cancer, lung cancer, or with metastatic cancer (stage IV) had the highest frequency of severe events. In addition, patients who received surgery had higher risks of having severe events, while patients with only radiotherapy did not demonstrate significant differences in severe events when compared to patients without cancer.
“These findings indicate that cancer patients appear more vulnerable to SARS-COV-2 outbreak. Since this is the first large cohort study on this topic, our report will provide the much-needed information that will benefit global cancer patients. As such, we believe it is extremely important that our study be disseminated widely to alert clinicians and patients,” stated Cai.
“Self-protective isolation, strict in-hospital infection control, and appropriate online medical services are recommended. On top of that, individualized treatment plans need to be developed based on the tumor types and stages of patients by clinicians.”