ABSTRACT
Introduction: SARS-CoV2 (S-2) infection duration (S-2-D) and its impact on patients with cancer and mild tomoderate COVID-19 undergoing cancer-directed therapy (CDT), especially in the underserved population, is notwell described. We conducted a retrospective study to analyze S-2 positive (+) patients on CDT to describe the S-2-D and its impact on CDT. Methods: 299 patients with cancer were tested with nasopharyngeal (NP) S-2 PCR assay at Columbia UniversityMedical Irving Center (CUIMC), a Minority-NCI Community Oncology site, of whom 77(26%) tested positive. Weretrospectively analyzed 25 S-2 (+) patients with mild to moderate COVID-19 receiving CDT. NP PCR wererepeated every one to two weeks until two successive negative (-) PCRs were obtained prior to restarting CDT. Timeto two (-) PCR and serology results were recorded. Cycling thresholds (Ct) were obtained for S-2 specific targetsand represented an indirect measure of viral load. Results: Demographics of N=25 patients included Hispanic (N=17, 68%), Black (N=1, 4%), White (N=6, 24%), andundeclared (N=1, 4%). Among the tumor histologies represented, gastrointestinal (N = 9, 36%), breast (N = 4, 16%), sarcoma (N = 3, 12%), and myeloma (N=2, 8%) were most common. Median time in days (d) to two (-) PCR was 24(6-69). Nine (36%) patients were persistently (+) for more than six weeks. 20 patients had CDT interruption with amedian time of 55 days off CDT. Two (10%) patients experienced disease progression during CDT interruption. 13patients had >1 sequential (+) PCR. The mean time between 1st and 2nd NP S-2 PCR was 16d. There was a non-statistically significant trend towards a higher S-2 specific Ct on the 2nd NP S-2 PCR as compared to the 1st (31.21vs 22.31, p=0.10). One patient was noted to be PCR (+) despite having developed S-2-specific IgG. Conclusion: Patients with cancer receiving CDT appear to have prolonged detectable S-2 by PCR, which can leadto interruption of CDT and POD in patients. Patients from underserved communities may be at greater risk givenhealth care disparities. Further data are needed to help select patients with mild to moderate COVID-19 who cansafely continue CDT while balancing the risk of worsening infection and risk of spread. The increased Ct over time inour patients suggest a decrease in viral load and infectious probability. Our lack of statistical significance is likelydue to small sample size. Ct along with serology can be tools to help guide when and which patients can restartCDT. However, these tests need further investigation for applicability and validity.