scholarly journals Safety of systemic anti-cancer treatment in oncology patients with non-severe COVID-19: a cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
C. van Marcke ◽  
N. Honoré ◽  
A. van der Elst ◽  
S. Beyaert ◽  
F. Derouane ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Adverse Events ◽  
Cancer Treatment ◽  
Performance Status ◽  
Rt Pcr ◽  
Bleeding Events ◽  
Oncology Patients ◽  
Treatment Delays ◽  
Ambulatory Oncology ◽  
Anti Cancer

Abstract Background The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is an important matter in daily practice. Methods ONCOSARS-1 was a single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were prospectively included. All patients (n = 363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the first peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to retrospectively determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients. Results Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P < 0.001). This association remained significant (odds ratio (OR) 4.1, P = 0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P < 0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-CoV-2-positive patients. Conclusion Systemic anti-cancer therapy appeared safe in ambulatory oncology patients treated during the COVID-19 pandemic. There were, however, more treatment delays in the SARS-CoV-2-positive population, mainly due to a higher rate of hematological adverse events.

scholarly journals Safety of systemic anti-cancer treatment in oncology patients with non-severe COVID-19: a prospective cohort study

2020 ◽  
Author(s):  
Cédric Van Marcke ◽  
Natasha Honoré ◽  
Athénaïs van der Elst ◽  
Simon Beyaert ◽  
Françoise Derouane ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Adverse Events ◽  
Cancer Treatment ◽  
Performance Status ◽  
Rt Pcr ◽  
Bleeding Events ◽  
Oncology Patients ◽  
Treatment Delays ◽  
Ambulatory Oncology ◽  
Anti Cancer

Abstract Background The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is unknown.Methods ONCOSARS-1 was a prospective, single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were included. All patients (n=363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients.Results Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P<0.001). This association remained significant (odds ratio (OR) 4.1, P=0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P<0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-CoV-2-positive patients.Conclusion Systemic anti-cancer therapy appeared safe in ambulatory oncology patients treated during the COVID-19 pandemic. There were, however, more treatment delays in the SARS-CoV-2-positive population, mainly due to a higher rate of hematological adverse events.

scholarly journals Management of oncology patients receiving anti-cancer treatment in the COVID-19 pandemic

2020 ◽  
Author(s):  
Esat Namal ◽  
Nur Dinc ◽  
Sezer Saglam ◽  
Ali Vefa Ozturk ◽  
Safiye Koculu ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
World Health ◽  
Rt Pcr ◽  
Oncology Patients ◽  
Rna Detection ◽  
Recommended Treatment ◽  
Anti Cancer ◽  
The World ◽  
Oropharyngeal Swab ◽  
Health Organization

Abstract Background/Aim: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has deeply affected life all over the World. The World Health Organization named this disease as COVID-19. The most important factor in the transmission of the disease is asymptomatic carriers. We’ve tested all oncology patients, that receive anti-cancer therapy, for COVİD-19 to prevent asymptomatic oncology patients from spreading infection and to make the decision to postpone chemotherapy in infected patients. Then, we analyzed the clinical and radiological findings of infected patients.Materials and Methods: Oncology patients who have indications of receiving anti-cancer treatment in the hospital were tested for COVID-19, two day prior to their treatment even if they were asymptomatic by collecting nasopharyngeal and oropharyngeal swab specimens for RT-PCR for viral RNA detection. Positive patients, underwent inspiratory phase of chest computed tomography (CT) examination. Infected patients were given the recommended treatment for COVID-19. Anti-cancer treatment of all patients that had positive PCR results was delayed for 14 days.Results: PCR test was positive in 28 of 312 patients that we tested, and the positivity rate was 8.9%. Three patients (10.7%) had symptoms; 2 of whom had dyspnea and cough, and 1 had headache, and 25 patients (89.3%) had no symptoms.Conclusion: In oncology patients, who are receiving anti-cancer treatment, we have to recognize the asymptomatic COVID-19 infection. We recommend testing for COVID-19 in oncology patients receiving chemotherapy, periodically or before each anti-cancer treatment, in order to continue their treatment without any problems and to prevent the risk of transmission.

scholarly journals Single Center Experience on Screening Oncology Patients for Covid-19 Before Anti-Cancer Treatment

2020 ◽  
Vol 30 (4) ◽  
pp. 207-212
Author(s):  
ESAT NAMAL
Keyword(s):  
Cancer Treatment ◽  
High Rate ◽  
Rt Pcr ◽  
Oncology Patients ◽  
Rna Detection ◽  
Asymptomatic Carriers ◽  
Single Center Experience ◽  
Recommended Treatment ◽  
Anti Cancer ◽  
Oropharyngeal Swab

The most important factor in the transmission of the COVID-19 is asymptomatic carriers. We’ve tested all oncology patients , that receive anti-cancer therapy, for COVID-19. We aimed to determine the rate of asymptomatic carriers, and analyze the clinical and ra- diological findings of infected patients. Oncology patients who have indications of receiving anti-cancer treatment in the hospital were tested for COVID-19, two day prior to their treatment even if they were asymptomatic by collecting nasopharyngeal and oropharyngeal swab specimens for RT-PCR for viral RNA detection. Positive patients, underwent inspiratory phase of chest computed tomography examination. Infected patients were given the recommended treatment for COVID-19. PCR test was positive in 28 of 312 patients that we tested, and the positivity rate was 8.9%. Three patients (10.7%) had symptoms, 25 patients (89.3%) had no symptoms. Covid-19 testing before anti-cancer treatment may be recommended in order to continue their treatment without any problems and to prevent the risk of transmission due to the high rate of asymptomatics in infected patients. Keywords: COVID-19, Pandemic, Chemotherapy, Oncology

scholarly journals Microbes as Medicines: Harnessing the Power of Bacteria in Advancing Cancer Treatment

2020 ◽  
Vol 21 (20) ◽  
pp. 7575 ◽  
Author(s):  
Shruti S. Sawant ◽  
Suyash M. Patil ◽  
Vivek Gupta ◽  
Nitesh K. Kunda
Keyword(s):  
Cancer Therapy ◽  
Cancer Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Genetically Engineered ◽  
Cancer Therapies ◽  
Anti Cancer ◽  
Tumor Environment ◽  
Systemic Side Effects ◽  
Hypoxic Tumor

Conventional anti-cancer therapy involves the use of chemical chemotherapeutics and radiation and are often non-specific in action. The development of drug resistance and the inability of the drug to penetrate the tumor cells has been a major pitfall in current treatment. This has led to the investigation of alternative anti-tumor therapeutics possessing greater specificity and efficacy. There is a significant interest in exploring the use of microbes as potential anti-cancer medicines. The inherent tropism of the bacteria for hypoxic tumor environment and its ability to be genetically engineered as a vector for gene and drug therapy has led to the development of bacteria as a potential weapon against cancer. In this review, we will introduce bacterial anti-cancer therapy with an emphasis on the various mechanisms involved in tumor targeting and tumor suppression. The bacteriotherapy approaches in conjunction with the conventional cancer therapy can be effective in designing novel cancer therapies. We focus on the current progress achieved in bacterial cancer therapies that show potential in advancing existing cancer treatment options and help attain positive clinical outcomes with minimal systemic side-effects.

scholarly journals Polymeric Co-Delivery Systems in Cancer Treatment: An Overview on Component Drugs’ Dosage Ratio Effect

Molecules ◽  
2019 ◽  
Vol 24 (6) ◽  
pp. 1035 ◽  
Author(s):  
Jiayi Pan ◽  
Kobra Rostamizadeh ◽  
Nina Filipczak ◽  
Vladimir Torchilin
Keyword(s):  
Cancer Therapy ◽  
Cancer Treatment ◽  
Therapeutic Agent ◽  
Polymeric Nanoparticles ◽  
Therapeutic Agents ◽  
Delivery Systems ◽  
Individual Therapy ◽  
Multiple Factors ◽  
Therapeutic Outcomes ◽  
Anti Cancer

Multiple factors are involved in the development of cancers and their effects on survival rate. Many are related to chemo-resistance of tumor cells. Thus, treatment with a single therapeutic agent is often inadequate for successful cancer therapy. Ideally, combination therapy inhibits tumor growth through multiple pathways by enhancing the performance of each individual therapy, often resulting in a synergistic effect. Polymeric nanoparticles prepared from block co-polymers have been a popular platform for co-delivery of combinations of drugs associated with the multiple functional compartments within such nanoparticles. Various polymeric nanoparticles have been applied to achieve enhanced therapeutic efficacy in cancer therapy. However, reported drug ratios used in such systems often vary widely. Thus, the same combination of drugs may result in very different therapeutic outcomes. In this review, we investigated polymeric co-delivery systems used in cancer treatment and the drug combinations used in these systems for synergistic anti-cancer effect. Development of polymeric co-delivery systems for a maximized therapeutic effect requires a deeper understanding of the optimal ratio among therapeutic agents and the natural heterogenicity of tumors.

Reviewing deaths within 30 days of systemic anti-cancer therapy: Driving quality in a regional chemotherapy service.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 112-112 ◽  
Author(s):  
Caroline Forde ◽  
Paula Scullin ◽  
Lynne Edgar ◽  
James J McAleer ◽  
Victoria M Coyle
Keyword(s):  
Cancer Therapy ◽  
Causes Of Death ◽  
Peer Review Process ◽  
Performance Status ◽  
Regional Chemotherapy ◽  
Service Improvement ◽  
City Hospital ◽  
Cancer Centre ◽  
Neutropenic Sepsis ◽  
Anti Cancer

112 Background: Systemic anti-cancer therapy (SACT) administration rate at the end of life has been deemed a key metric for assessing quality of cancer care. A structured peer review process has been developed within the Cancer Centre, Belfast City Hospital, to discuss all patient deaths occurring within 30 days of SACT across Northern Ireland at a monthly, multidisciplinary, educational mortality meeting. We aimed to review cases discussed, characterising patients, causes of death and the role of SACT in patients’ deaths. Methods: A retrospective analysis was undertaken of 282 solid tumour patients, whose deaths were discussed at the mortality meetings from January 2013 to August 2016. Results: The 30-day mortality rate for the Cancer Centre was 4.5%. Most commonly represented tumour sites were gastrointestinal (39%), lung (22%) and breast (17%) with 96% receiving palliative treatments. WHO Performance Status (PS) was 0-2 at final SACT cycle in 83% (8% PS 3, unknown 9%). 43% of patients were receiving their first cycle and 56% receiving first line treatment for advanced disease. 77% of deaths occurred in hospital with 57% attributed to progressive disease. Other causes of death included infection (7% neutropenic, 11% non-neutropenic) and thromboembolism (12%). In 10% SACT was deemed to have caused or hastened death whereas in 65% SACT was non-contributory. In 25% SACT did not play a major role, but a contributory role could not be confidently excluded. Conclusions: SACT related death rate appears comparable to other institutions’ published routine outcomes. Robust review of SACT mortality encourages service improvement and individual reflection. Prescribers are reminded of the critical importance of carefully balancing patients’ needs and concerns with realistic outcomes and treatment risks, particularly in heavily pretreated or poor PS patients. Case discussions have generated service improvements including site and regimen specific prepopulated consent forms, a standardised SACT assessment proforma and mandatory response assessments as part of SACT protocols. Neutropenic sepsis remains the leading cause of SACT related mortality and further innovative improvements in care are required.

Experience of immune-related adverse events associated with ipilimumab and nivolumab in a single center.

2017 ◽  
Vol 35 (7_suppl) ◽  
pp. 91-91 ◽  
Author(s):  
Bernardo Leon Rapoport ◽  
Teresa Smit ◽  
Ronwyn van Eeden
Keyword(s):  
Adverse Events ◽  
Metastatic Melanoma ◽  
Performance Status ◽  
Death Receptor ◽  
Endocrine System ◽  
Organ Systems ◽  
Anti Cancer ◽  
Life Threatening ◽  
Prompt Diagnosis ◽  
Cell Death Receptor

91 Background: Anti-programmed cell death receptor-1 (PD-1) and anti-CTLA4 antibodies represent an effective anti-cancer. Ipilimumab and nivolumab can induce immune-related adverse events (IrAEs). These IrAEs affect skin, gastrointestinal tract, liver, endocrine system and other organ systems. Life-threatening and fatal irAEs have been reported; adequate diagnosis and management are essential. Methods: A retrospective review of data from 40 patients (pts) records were used to describe the IrAE’s associated with 15 pts treated with ipilimumab and 25 pts treated with nivolumab. Results: A total of 40 pts (25 males and 15 females) were included in the analysis. The median age was 63 years (range 30 - 85 years). The performance status (PS) ranged from 0 to 2, with a median PS of 1. In total, 3 pts with metastatic melanoma, 18 with non small cell lung cancer (NSCLC), 2 with renal cell carcinoma and 2 with Hodgkin’s disease were treated with nivolumab and 15 with metastatic melanoma received ipilimumab. A total of 167 cycles of nivolumab (median = 4, range 1-16) and 60 cycles of ipilimumab (median = 4 cycles, range 1-4 cycles) were administered. Seven IrAEs are described in 19 pts treated with ipilimumab. These include endocrinopathy in 3 pts (hypophysitis in pt and hyphothyroidsm in 2 pts), colitis in 3 pts (1 required infliximab) and hepatitis in 1 pt. Among the pts treated with nivolumab 7 IrAEs were documented. These included pneumonitis in 2 pts, skin rash in 3 pts, mild diarrhea in 1 pt and mild uveitis in 1 pt. Additionally, 3 chest infections were documented including a case of pulmonary tuberculosis in a pt with NSCLC. Conclusions: Anti-PD1 and anti-CTLA4 antibodies can induce a plethora of irAEs. Colitis was more common with ipilimumab while pneumonitis more common with nivolumab. The knowledge of IrAE’s will allow prompt diagnosis and improve the management resulting in decreased morbidity.

The Emirates Oncology Task Force Clinical Practice Guideline on Screening for SARS-CoV-2 in Asymptomatic Adult Cancer Patients Prior to Anti-Cancer Therapy (Preprint)

2020 ◽  
Author(s):  
Humaid Al-Shamsi ◽  
Ibrahim Abu-Gheida ◽  
Amr Hassan ◽  
Fathi Azribi ◽  
Hassan Jaafar ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Therapy ◽  
Cancer Patients ◽  
Task Force ◽  
Serum Antibody ◽  
Risk Groups ◽  
Rt Pcr ◽  
Asymptomatic Patients ◽  
Anti Cancer ◽  
Asymptomatic Adult

BACKGROUND Cancer care during this pandemic is challenging given the competing risks of death from cancer versus death or serious complications from SARS- CoV-2 infection, and the likely higher lethality of COVID-19 in immunocompromised patients. Question remains on serial screening for SARS-CoV-2 in asymptomatic adult cancer patients prior to anti-cancer therapy during the COVID-19 pandemic. OBJECTIVE Formulate a consensus guideline statement to guide practicing physicians METHODS We conducted a systematic review to formulate a consensus statement to guide the practising oncologists RESULTS Most of the current guidelines recommend RT-PCR SARS-CoV-2 testing of asymptomatic patients prior to initiating and during the anti-cancer therapy despite the lack of robust evidence. We suggested the following: If screening is indicated in adult cancer patients, we recommend using RT-PCR over serum antibody or serum antigen for adult cancer patients; we also recommend assessing the risk of exposure to and infection from SARS-CoV-2 prior to each anti-cancer cycle, to consider SARS-CoV-2 in asymptomatic adult cancer patients prior to anti-cancer therapy in high risk groups : highly cytotoxic chemotherapy with potential profound neutropenia based on the physician’s risk assessment of the chemotherapy , stem cell transplantation. For asymptomatic intermediate-high risk cancer patients, we suggest performing RT-PCR 48-72 hours prior to initiating any anti-cancer therapy. For asymptomatic low-risk cancer patients, we suggest not to routinely screen prior to initiating any anti-cancer therapy (weak recommendation, low quality evidence). CONCLUSIONS SARS-CoV-2 screening might be indicated with higher certainty to certain cancer risk groups. There remains a need for prospective trials to assess this intervention, and the outcome of such intervention. Current recommendations may change based on new and emerging evidence.

Effect of interval between diagnosis of advanced cancer and cessation of active anti-cancer treatment on survival in terminally ill cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20630-e20630
Author(s):  
Y. Kim ◽  
J. Lee ◽  
W. Choi ◽  
J. Park ◽  
H. Kim ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Performance Status ◽  
Terminally Ill ◽  
Time Interval ◽  
Terminally Ill Cancer Patients ◽  
Terminal Stage ◽  
Anti Cancer

e20630 Background: Although various prognostic factors have been proposed to predict survival in terminally ill cancer patients, accurate prognostication is still a challenging task for oncologists. The objective of this study was to evaluate whether the time interval between diagnosis of advanced cancer and cessation of active anti-cancer treatment (ATP; active treatment period) can predict survival in terminally ill cancer patients. Methods: We prospectively evaluated 79 patients with advanced (recurrent or metastatic) cancer who were determined as terminal stage, namely cessation of active anti-cancer treatment and transition to palliative care, by attending oncologists. ATP and other known prognostic factors including clinical symptoms and signs, performance status, laboratory tests, and clinical prediction of survival (CPS) were analyzed. Results: Of the 79 patients, 46 were male (58%) and 33 were female (42%) with a median age of 60 years (range, 21–82). Median overall survival after being diagnosed with advanced cancer was 11.6 months (95% confidence interval (CI), 8.02–15.18), and survival after being determined as terminal stage was 1.9 months (95% CI, 1.38–2.42). According to 3 ATP categories (< 3months, 3–12 months, and >12 months), terminal stage survival were 1.0 month, 1.8 months, and 3.6 months, respectively (p=0.002). On multivariate analysis, short ATP, non-colorectal cancer, fatigue, and Karnofsky performance status less than 50 were significantly associated with a poor prognosis. Conclusions: Our study suggests that ATP is an independent prognostic factor for survival in terminally ill cancer patients who cannot receive active anti-cancer treatment anymore. Future prognostic models should include ATP as a prognostic variable. No significant financial relationships to disclose.

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