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AACR 2020: What Does Cancer Therapy Mean in the Time of COVID-19?
By Sahana Shankar, Ph.D. Candidate
One of the biggest challenges that healthcare professionals face during this COVID-19 pandemic is to prevent comorbidities in patients who already suffer from a wide spectrum of debilitating medical conditions. When exposed to the SARS-CoV-2, this vulnerable population may have a severe negative impact on their recovery and survival. Cancer patients are a high-risk group since chemotherapy suppresses the immune response and they are prone to higher comorbidities. Since the pandemic is an evolving situation, hospitals are developing their response programs to assess and reduce risk, provide safety to patients and caregivers.
The virtual clinical plenary session at the AACR 2020 virtual conference focused on understanding how oncologists and hospitals are dealing with safety and containment protocols, the response of cancer patients to SARS-CoV-2 infection, the impact of COVID-19 on cancer treatments and the effect of common cancer drugs on the virus. Based on the preliminary clinical trials and anecdotal data in the last 2 months, clinicians from Madrid, Wuhan, New York, and Naples shared some of their observations in treating cancer patients in the wake of the COVID-19 pandemic. These are important to understand the increased risks, potential therapeutic options, and current management strategies.
Adapting Oncologic Practice to COVID-19 Outbreak
Carlos Gomez-Martin of Octubre University Hospital, Madrid, Spain discussed the development of a contingency procedure to screen, isolate, and treat cancer patients. By limiting the outpatient traffic, conducting virtual follow-up consultations, and testing patients in wards, they were able to isolate the infected individuals from COVID-19-suspected and COVID-19-negative patients. Chemotherapy treatments were reconsidered based on the clinical status of each patient and the current status of their therapy. To predict outcomes, they developed a multi-tier criteria based on age, comorbidities, current chemotherapy, and clinical features such as bilateral infiltrates in Chest X-ray, and neutropenia.
Detailing the features of 63 COVID-19 positive cancer patients, Dr. Gomez-Martin’s data suggested that patients with lung cancer or metastasis to lung had a poor prognosis. 54% of patients developed Acute Respiratory Distress Syndrome (ARDS) and needed mechanical ventilation and 25% died due to COVID-19. They also noted that COVID-19 increased the risk of vascular complications in patients on anticoagulant therapy. Tocilizumab, an anti-IL6 monoclonal antibody is a common drug used in chemotherapy to treat the cytokine storm. Preliminary clinical data from Dr.Gomez-Martin showed that Tocilizumab can treat ARDS since it induces an anti-inflammatory response, indicating a potential drug candidate. These data demonstrated significant relationships between clinical and analytical parameters and increased risk of severe pulmonary and vascular events in cancer patients.
Using Cancer Drugs to Combat COVID-19
In a concomitant, independent study, Dr. Paolo Ascierto, Director of the Department of Melanoma, Cancer Immunotherapy and Development Therapeutics at the National Tumor Institute, Naples, Italy asserted that treating the cytokine storm due to ARDS in COVID-19 may be a possible therapeutic avenue. He shared clinical data from collaborators which reported favorable outcomes in 20/21 patients for ARDS using Tocilizumab therapy and clinical cases from his own department with similar results. This prompted a phase II clinical trial with 330 patients, the data of which should be available shortly. They also found that patient’s response to anti-IL6 therapy can be measured by absolute lymphocyte levels and CRP (C-Reactive Protein) biomarkers. Additionally, he shared the triage conditions he has instituted at the Department of Melanoma, Cancer Immunotherapy.
COVID-19 and Cancer Risk
From a comprehensive multi-center study in Hubei province, China, Dr. HongBing Cai of Zhongnan Hospital of Wuhan University demonstrated that cancer patients are more vulnerable to COVID-19. A large cohort clinical involving 105 cancer patients and 536 age-matched non-cancer patients showed that COVID-19 patients had higher risks in all severe outcomes if they are also affected by cancer. Patients with hematological, lung or metastatic cancer (stage IV) had the highest frequency of severe events. Non-metastatic cancer patients experienced similar frequencies of severe conditions to those observed in patients without cancer. 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 the SARS-COV-2 outbreak.
Disparities in the Severity of Comorbidities Between Ethnic Groups
In a slightly different vein, Louis Voigt, MD from Memorial Sloan Kettering Cancer Centre in New York drew attention to cancer health disparities in the United States in ethnic minorities and disenfranchised communities in the context of COVID-19. Data from AACR and CDC suggest different rates of incidence and mortality in several cancers for different ethnic groups. Due to inequalities in the diagnosis and management of cancers in Hispanics and African-Americans, there are disproportionate outcomes and fatalities. More than half of COVID-19 cases and fatalities in New York are in these communities. The trend is similar across several cities and states in the country, suggesting that some communities may be more vulnerable than others. However, the reasons may not be straightforward. He raised questions on how socioeconomic status-determinants and disparities, race, ethnicity, limited English proficiency, physical and social distancing may impact cancer and COVID-19 therapy, since overwhelmed healthcare systems may not cater to vulnerable groups as robustly as needed.
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