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Live Notes, Real Time Conference Coverage 2020 AACR Virtual Meeting April 28, 2020 Session on COVID-19 and Cancer 9:00 AM

Reporter: Stephen J. Williams, PhD

 

COVID-19 and Cancer

Introduction

Antoni Ribas
UCLA Medical Center

  • Almost 60,000 viewed the AACR 2020 Virtual meeting for the April 27 session
  • The following speakers were the first cancer researchers treating patients at the epicenters of the pandemic even though nothing was known about the virus

 

The experience of treating patients with cancer during the COVID-19 pandemic in China
Li Zhang, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

  • reporting a retrospective study from three hospitals from Wuhan
  • 2.2% of Wuhan cancer patients were COVID positive; most were lung cancers and most male; 35% were stage four
  • most have hospital transmission of secondary infection; had severe events when admitted
  • 74% were prescribed antivirals like ganciclovir and others; iv IgG was given to some
  • mortailtiy rate of 26%; by April 4 54% were cured and discharged; median time of infection to severe event was 7 days; clinical presentation SARS sepsis, and shock
  • by day 10 in lung cancer patients, see lung path but after supportive therapy improved
  • cancer patients at stage four who did not receive therapy were at higher risk
  • cancer patients who had received chemo in last 14 days had higher risk of infection
  • they followed up with cancer patients on I/O inhibitors;  it seemed there was only one patient that contracted COVID19 so there may not be as much risk with immune checkpoint inhibitors

 

TERAVOLT (Thoracic cancERs international coVid 19 cOLlaboraTion): First results of a global collaboration to address the impact of COVID-19 in patients with thoracic malignancies

Marina Chiara Garassino

@marinagarassino
Fondazione IRCCS Istituto Nazionale dei Tumori

Dr Marina Chiara Garassino is the Chief of the Thoracic Oncology Unit at Istituto Nazionale dei Tumori, Milan, Italy. She leads the strategy for clinical and translational research in advanced and locally advanced NSCLC, SCLC, mesothelioma and thymic malignancies. Istituto Nazionale dei Tumori in Milan is the most important comprehensive cancer in Italy and one of the most important in Europe. As a medical oncologist, she has done research in precision medicine and in immuno-oncology. Her main research interests have been mainly development of new drugs and therapeutical strategies and biomarkers. She has contributed to over 150 peer-reviewed publications, including publications as first or last author in the New England Journal of Medicine, Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology. She has delivered many presentations at international congresses,  including  AACR, ASCO, ECCO, ESMO, WCLC. Her education includes a degree and further specialization in Medical Oncology at Università degli Studi in Milan. She achieved a Master Degree in Oncology management at University of Economics “Luigi Bocconi”. She completed her training with an ESMO Clinical fellowship in 2009 at Christie’s Hospital in Manchester (UK). She was a member of the EMA SAG (Scientific Advisory Group). She is serving as ESMO Council member as the Chair of the National Societies Committee. She was the ESMO National Representative for Italy for 5 years (2011-2017). She is serving on several ESMO Committees (Public Policy extended Committee, Press Committee, Women for Oncology Committee, Lung Cancer faculty, Membership Committee).She used to be an active member of the Young Oncologist Committee. She’s serving on both ESMO, WCLC and ASCO annual congress Lung Cancer Track (2019, and 2020), Chair of ESMO National Societies, from 2019. She is the founder and president of Women for Oncology Italy.

  • 2 million confirmed cases but half of patients are asymptomatic and not tested; pooled prevalance of COVID in cancer patients in Italy was 2%; must take them as high risk patients
  • they were not prepared for pandemic lasting for months instead of days; March 15 in middle of outbreak they started TERAVOLT registry; by March 26 had IRB approval; they are accruing 17 new patients per week; Ontario also joined in and has become worldwide (21 countries involved);  in registry they also included radiologic exams and COVID testing result
  • most patients were males and many smokers; 75% had SCLC; 83% of cases had one comorbility like hypertension and one third had at least one comorbility; 73.9% of patients were on treatment (they see this in their clinic: 30% on chemo or TKI alone; other patients were just on folowup
  • most of symptoms overlap with symptoms of lung cancer like pneumonia and pneumonitits and multi organ failure; most were hospitalized
  • unexpected high mortality among lung cancer patients with COVID19; this mortality seems due to COVID and not to cancer;
  • study had some limitations like short followup and some surgical cases so some bias may be present
  • she stresses don’t go it alone and make your own registry JOIN A REGISTRY

 

Outcome of cancer patients infected with COVID-19, including toxicity of cancer treatments
Fabrice Barlesi @barlesi
Gustave Roussy Cancer Campus

Professor Fabrice Barlesi
 As a specialist in lung cancer, precision medicine and cancer immunology, Prof. Fabrice Barlesi is a major contributor to research in the field of novel oncological therapies. He was apppointed General Director of Gustave Roussy in January 2020.
Fabrice Barlesi is Professor of Medicine at the University of Aix-Marseille. He has been head of the Multidisciplinary Oncology and Innovative Therapies Department of the Nord Hospital in Marseille (Marseille Public Hospitals) and the Marseille Centre for Early Trials in Oncology (CLIP2) which were established by him. He holds a doctorate in Sciences and Management with methods of analysis of health care systems, together with an ESSEC (international business school) master’s degree in general hospital management.
Professor Barlesi was also a co-founder of the Marseille Immunopôle French Immunology network, which aims to coordinate immunological expertise in the Aix-Marseille metropolitan area. In this context, he has organised PIONeeR (Investment in the future RHU 2017), the major international Hospital-University research project whose objective is to improve understanding of resistance to immunotherapy – anti-PD1(L1) – in lung cancer and help to prevent and overcome it. He was also vice-chair of the PACA (Provence, Alps and Côte d’Azur) Region Cancer Research Directorate.
Professor Barlesi is the author and co-author of some 300 articles in international journals and specialist publications. In 2018, the European Society of Medical Oncology (ESMO) and the International Association for the Study of Lung Cancer (IASLC) awarded him the prestigious Heine H. Hansen prize. He appears in the 2019 world list of most influential researchers (Highly cited researchers, Web of Science Group).
  • March 14 started protective measures and at peak had increased commited beds at highest rate
  • 12% of cancer patients tested positive for COVID; (by RTPCR); they curated data across different chemo regimens used
  • they retrospectively collected data; primary endpoint was clinical worsening; median of disease 13 days;
  • they actually had more breast cancer patients and other solid malignancies; 23% of covid cases no symptoms; 83% finally did have the symptoms after followup; diarhea actually in 10% of cases so clinics are seeing this as a symptom
  • CT scan showed 66% cases had pneumonitits like display; 25% patients were managed as outpatient
  • 24% patients worsened during treatment but 75% were able to go home (treated at home or well)
  • I/O did not have negative outcome and you can use these drugs without increasing risk to COVID
  • although many clinical trials have been hindered they are actively recruiting for COVID-cancer studies
  • outcomes with respect to death and symptoms are comparable to worldwide stats

Adapting oncologic practice to COVID19 outbreak: From outpatient triage to risk assessment for specific treatment in Madrid, Spain
Carlos Gomez-Martin
Octubre University Hospital

  • MOST slides were DO NOT POST so as requested data will not be shown; this study will be published soon
  • Summary is that Spain is seeing statistics like other European countries and similar results
  • Tocilizumab, the IL6 antagonists had been suggested as a treatment for cytokine storm and they are involved in a trial with this agent; results will be published

Experience in using oncology drugs in patients with COVID-19

Paolo A. Ascierto
Istituto Nazionale Tumori IRCCS Fondazione Pascale

  • giving surgery only for patients at highest risk of cancer mortality so using neoadjuvant therapy more often
  • telemedicine is a viable strategy for patient consult
  • for metastatic melanoma they are given highest priority for treatment
  • they are conducting a tocilizumab clinical trial and have accrued over 300 patients
  • results are in press so please look for publication soon
  • also can use TNF inhibitor, JAK inhibitor, IL1 inhibitor to treat cytokine storm

COVID-19 and cancer: Flattening the curve but widening disparities
Louis P. Voigt
Memorial Sloan Kettering Cancer Center

  • Sloan has performed about 5000 COVID tests;  78 patients needed hospitilization; 15 died; 40% still in ICU
  • they do see many African American patients
  • mortality rates in US (published) have been around 50-60 % for cancer patients with COVID; Sloan prelim results are lower but still accruing data

Patients with cancer appear more vulnerable to SARS-COV-2: A multi-center study during the COVID-19 outbreak
Hongbing Cai
Zhongnan Hospital of Wuhan University

  • metastatic cancer showed much higher risk than non cancer but non metastatic showed increased risk too
  • main criteria of outcome was ICU admission
  • patients need to be isolated and personalized treatment plans need to be made
  • many comparisons were between non cancer and cancer which was clearest significance; had not looked at cancer types or stage grade or treatment
  • it appears that there are more questions right now than answers so data collection is a priority

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For other Articles on the Online Open Access Journal on COVID19 and Cancer please see

https://pharmaceuticalintelligence.com/coronavirus-portal/

Opinion Articles from the Lancet: COVID-19 and Cancer Care in China and Africa

Actemra, immunosuppressive which was designed to treat rheumatoid arthritis but also approved in 2017 to treat cytokine storms in cancer patients SAVED the sickest of all COVID-19 patients

The Second in a Series of Virtual Town Halls with Leading Oncologist on Cancer Patient Care during COVID-19 Pandemic: What you need to know

Responses to the COVID-19 outbreak from Oncologists, Cancer Societies and the NCI: Important information for cancer patients

 

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