Changes in anticancer treatment plans in patients with solid cancer hospitalized with COVID-19: analysis of the nationwide BSMO-COVID registry providing lessons for the future.

BACKGROUND: Solid cancer is an independent prognostic factor for poor outcome with COVID-19. As guidelines for patient management in that setting depend on retrospective efforts, we here present the first analyses of a nationwide database of patients with cancer hospitalized with COVID-19 in Belgium, with a focus on changes in anticancer treatment plans at the time of SARS-CoV-2 infection. METHODS: Nineteen Belgian hospitals identified all patients with a history of solid cancer hospitalized with COVID-19 between March 2020 and February 2021. Demographic, cancer-specific and COVID-specific data were pseudonymously entered into a central Belgian Society of Medical Oncology (BSMO)-COVID database. The association between survival and primary cancer type was analyzed through multivariate multinomial logistic regression. Group comparisons for categorical variables were carried out through a Chi-square test. RESULTS: A total of 928 patients were registered in the database; most of them were aged ≥70 years (61.0%) and with poor performance scores [57.2% Eastern Cooperative Oncology Group (ECOG) ≥2]. Thirty-day COVID-related mortality was 19.8%. In multivariate analysis, a trend was seen for higher mortality in patients with lung cancer (27.6% versus 20.8%, P = 0.062) and lower mortality for patients with breast cancer (13.0% versus 23.3%, P = 0.052) compared with other tumour types. Non-curative treatment was associated with higher 30-day COVID-related mortality rates compared with curative or no active treatment (25.8% versus 14.3% versus 21.9%, respectively, P < 0.001). In 33% of patients under active treatment, the therapeutic plan was changed due to COVID-19 diagnosis, most frequently involving delays/interruptions in systemic treatments (18.6%). Thirty-day COVID-related mortality was not significantly different between patients with and without treatment modifications (21.4% versus 20.5%). CONCLUSION: Interruption in anticancer treatments at the time of SARS-CoV-2 infection was not associated with a reduction in COVID-related mortality in our cohort of patients with solid cancer, highlighting that treatment continuation should be strived for, especially in the curative setting.

Short and medium-term outcomes of patients with solid cancer hospitalized with COVID-19 in Belgium according to cancer diagnosis and treatment characteristics

Background: Solid cancer is an independent prognostic factor for COVID-19 related mortality. Adverse prognostic factors in these patients include low performance status, lung cancer, advanced cancer stage and recent diagnosis. In this study, we further evaluated prognostic effects of cancer diagnosis and treatment variables and characterized changes in anticancer treatment plans due to COVID-19 diagnosis in a nation-wide cohort study. Methods: Patients with a history of solid cancer hospitalized with COVID-19 between March 2020 and February 2021 in one of the 20 participating institutions in Belgium were included. Patient demographics, comorbidities, COVID-19 hospitalization course and treatment, cancer and anticancer treatment characteristics, treatment changes due to COVID-19 and clinical outcomes in-hospital and during follow-up were retrospectively registered in a central database. The primary objective was to evaluate potential differences in 30-day and 3-month COVID-19-related mortality according to cancer and anticancer treatment characteristics. Results: A total of 946 patients (median age 73y, interquartile range 64-81y) were included. Pre-existing comorbidities were present in 90.1% of patients, and 21.9% had a history of > 1 malignancy. Half of the patients (n = 463, 49.3%) had received anticancer treatment ≤3 months before COVID-19 diagnosis (“active cancer”), of whom 286 (63.1%) in the non-curative setting. The overall 30-day and 3-month COVID-19- related mortality rates in this cohort were 21.4% (n = 178) and 24.1% (n = 194), respectively. COVID- related 3-month mortality was comparable in patients with active cancer (n = 96, 24.3%) and in patients with non-active cancer (n = 97, 24.0%), but within the first group COVID-related mortality was higher in those receiving systemic treatment in the non-curative (28.3%) versus the curative setting (15.2%). A change in the anticancer treatment plan due to COVID-19 was recorded in 148/463 patients with active cancer (32.0%). In patients with changes in systemic treatment plans (n = 146), treatment was delayed in 94 patients (in half of cases for > 1 month) and cancelled in 42 patients. The main reason for modifications in anti-cancer treatment was COVID-19 related complications (79.6%), followed by fear for/existence of anticancer treatment related toxicity (14.8%). Conclusions: Our nation-wide analysis in patients with solid cancer hospitalized with COVID-19 shows comparable 3-month mortality among patients who did and who did not receive anticancer treatment in the three months before COVID-19 diagnosis. Changes in anticancer treatment were very frequent in patients hospitalized with COVID-19. Further monitoring of the long-term impact of COVID-19-related changes to anticancer treatment plans is warranted.

Risk of SARS-CoV-2 infection and outcome after infection: Experience from the day-care unit at CHU Liège in Belgium

Background: No specific safety data concerning systemic oncological treatments were available at time of COVID-19 outbreak in Belgium. In our hospital we decided to maintain adjuvant and early line treatments for metastatic disease in patients under 65 and without specific comorbidities and to apply a shared decision approach in other patients while following closely the safety of these treatments. Method(s): Real time safety monitoring was proposed to all patients treated for solid tumours in our day-care unit starting March 1st, 2020. After signing informed consent patients were asked questions concerning protective measures at home, signs of SARS-CoV-2 infection and hospitalisation. Patients' charts were reviewed for outcome, including death, after suspected or proven SARS-CoV-2 infection. Minimum follow-up was 5 weeks after day care unit attendance. Result(s): 387 patients were included in our registry between March 1st and March 31st, 2020. Median age was 64 years-old (range 27-90). Most patients suffered from lung (n=96), breast (n=93), gastrointestinal (n=87), gynaecological (n=38) or urological (n=33) cancers. 131 patients received (neo)adjuvant treatments, 256 patients were treated for metastatic disease. Patients received chemotherapy (n=170), immunotherapy (n=103), targeted therapy (n=68) or other combinations (n=46). Although Belgium had one of the highest infection rates in the world, safety data concerning risk of SARS-CoV-2 infection and outcomes were rather reassuring. A total of 11 patients had either suspected (n=5, 1.3%) or proven (n=6, 1.6%) SARS-CoV-2 infection. Only one 74 years old patient died of COVID-19, another 51 years old patient died of progressive disease but presented also suspicion of SARS-CoV-2 infection at the time of death. Conclusion(s): Analysis of our data for patients treated in March 2020 in the day-care unit are reassuring and suggest higher risk related to under-treatment compared to risk related to continuation of systemic therapy at time of COVID-19 outbreak. Patients' follow-up will be updated and additional analyses and data in particular for April 2020, when the infection rate was still extremely high in Belgium, will be presented. Legal entity responsible for the study: The authors. Funding(s): Fondation Leon Fredericq. Disclosure: A. Rorive: Travel/Accommodation/Expenses: BMS;MSD. B. Sautois: Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen;Advisory/Consultancy: Clovis;Sanofi;Astellas. J. Collignon: Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Amgen;Pfizer;Advisory/Consultancy: Servier;Bayer;Merck;Lilly;Sanofi;Sirtex;Celgene;Ipsen;Novartis. P. Freres: Advisory/Consultancy: Ipsen;Merck;BMS. C. Gennigens: Advisory/Consultancy, Research grant/Funding (institution): Astra-Zeneca;Advisory/Consultancy: BMS;GSK;Lilly;MSD;Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Pfizer;Pharmamar;Roche. G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Roche;Pfizer;Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Lilly;Advisory/Consultancy, Research grant/Funding (institution): Amgen;Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;AstraZeneca;Daiichi Sankyo;Advisory/Consultancy: Abbvie;Travel/Accommodation/Expenses: Medimmune;MerckKGaA. All other authors have declared no conflicts of interest.Copyright © 2020

How do oncological patients perceive the COVID-19 pandemic? Experience from CHU Liège in Belgium

Background: No data concerning systemic oncological treatments' safety during COVID-19 outbreak were available in Belgium. The aim of this study is to analyse patients’ perception of both the risk of infection and the need for change in clinical practice in oncology. Methods: A 12-items questionnaire using the Likert scale for 11 of these questions concerning the patients’ perception of COVID-19 was distributed to patients admitted for systemic therapy of solid tumours in our day-care unit between April 14th and 30th, 2020 (4-6 weeks after lockdown in Belgium). Results: 237 patients were included in our research project after signing an informed consent. Median age was 63 years-old (range 26-90). Most patients suffered from lung (n=59), breast (n=54), gastrointestinal (n=47), gynaecological (n=34) or urological (n=16) cancers or melanoma (n=15). 87 patients received (neo)adjuvant treatments, 150 patients were treated for metastatic disease. Patients received chemotherapy (n=106), immunotherapy (n=60), targeted therapy (n=36) or combinations (n=35). The patients who estimated their risk of dying because of COVID-19 infections as <0.1%, 1%, 10%, 20%, 50% or 100% were respectively 9.7%, 15.2%, 13.5%, 6.3%, 32.4%, 11.4% (no opinion: 10.8%). Most patients agreed (21.5%) or strongly agreed (64.6%) that it is important for them to receive the best cancer treatment available even if this may increase the infection risk. Very few patients agreed (1.3%) or strongly agreed (2.5%) that they were considering stopping the ongoing therapy because of the COVID-19 outbreak. Most patients agreed (33.8%) or strongly agreed (49.4%) that the institution was doing everything possible for risk reduction of contamination while receiving the therapy in the day-care unit. Conclusions: Although patients evaluated the risk of dying due to COVID-19 infection as extremely high, they are still asking for the best oncological care available. The majority recognize the effort of the institution in minimizing infectious risk. Additional analyses will be reported at time of presentation. Questionnaires will be repeated 3 months after the peak of the COVID-19 outbreak. Legal entity responsible for the study: The authors. Funding: Fondation Leon Fredericq. Disclosure: A. Rorive: Travel/Accommodation/Expenses: MSD;Travel/Accommodation/Expenses: BMS. B. Sautois: Advisory/Consultancy, Travel/Accommodation/Expenses: Janssen;Advisory/Consultancy: Clovis;Advisory/Consultancy: Sanofi;Advisory/Consultancy: Astellas. A. Sibille: Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;MSD;Boehringer Ingelheim;Roche;Advisory/Consultancy: AstraZeneca;Takada. J. Collignon: Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Amgen;Pfizer;Advisory/Consultancy: Servier;Bayer;Merck;Lilly;Sanofi;Sirtex;Celgene;Ipsen;Novartis. C. Gennigens: Advisory/Consultancy, Research grant/Funding (institution): Astra-Zeneca;Advisory/Consultancy: BMS;GSK;Lilly;MSD;Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Pfizer;Pharmamar;Roche. P. Freres: Advisory/Consultancy: Ipsen;Merck;BMS. G. Jerusalem: Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Novartis;Roche;Pfizer;Advisory/Consultancy, Travel/Accommodation/Expenses: Lilly;Amgen;BMS;AstraZeneca;Daiichi Sankyo;Advisory/Consultancy: Abbvie;Travel/Accommodation/Expenses: Medimmune;MerckKGaA. All other authors have declared no conflicts of interest.