ABSTRACT
Introduction: There are limited options for the treatment of malignant mesothelioma (MM) following progression with pemetrexed-platinum chemotherapy. Recently, nivolumab showed a survival benefit over placebo in this setting. In the UK, since April 2020, nivolumab has been funded through the interim national COVID-19 cancer plan. We assessed the real-world efficacy and toxicity outcomes in MM patients treated with nivolumab at Guy’s Cancer Centre.Methods: We identified all chemotherapy-pre-treated patients administered single-agent nivolumab for MM. Baseline characteristics, treatment, response, survival and treatment-related adverse events (TRAEs) were assessed. Best responses – disease control or progression – were derived from radiologic and clinical documentation. Results: Twenty patients were identified. Median age was 72 years (range 45 – 85), 80% male and 95% had epithelioid (5% sarcomatoid) disease. Programmed death-ligand 1 (PD-L1) measurements were unavailable. Nineteen (95%) had pleural and one peritoneal MM. ECOG PS was 0, 1 or 2 in 1 (5%), 16 (80%) and 3 (15%) patients respectively. All were previously exposed to pemetrexed-platinum chemotherapy, and 4 (20%) had received rechallenge. Median time from prior treatment to commencement of nivolumab was 6 months. Median follow-up was 10.8 months. Median number of two-weekly 240mg equivalent cycles administered was twelve. Best response was disease control in 17 (85%) patients and progressive disease in 3 (15%). Median progression-free survival was 5.0 months (95% CI 3.7 – 6.2). Six patients (30%) had died by time of analysis, with median overall survival not reached. Twenty TRAEs were seen among 14 patients (70%), all except one graded 1/2 (Table 1). Conclusions: Nivolumab proved a safe and effective way to deliver non-myelosuppressive anticancer therapy at a favourable dosing schedule to a vulnerable population during the COVID-19 pandemic. These real-world outcomes corroborate findings from the CONFIRM trial, although limited by small sample size and retrospective nature.
ABSTRACT
Background: There is evidence that the social, economic and health burdens, including weight gain, of the COVID-19 pandemic, were greater in women than men. Most of the available data is observational in nature, and the influence of the pandemic on treatment programs is of importance, especially as it relates to gender. To our knowledge, no one has examined the impact of gender on weight loss program outcomes during the COVID-19 quarantine year (2020). Methods: In gender specific analyses, we examined program retention and weight loss across 20 weeks of an employer sponsored online behavior-based weight loss program (Wondr Health) during the time periods of 2019 (pre-covid) and 2020 (active pandemic). In 2019, the sample contained 80,998 participants (75.5% women) and 54,363 participants (73.4 %women) in 2020. We examined weekly weight loss as a percent as well as percent of the population that achieved at least 5% weight loss at some point in the program. Results: In neither, women nor men, was there a difference in weekly retention when comparing 2019 to 2020. For women, at every program week mean weight loss was less in 2020 compared to 2019. For example, cumulative weight loss at week 20 in 2019 was -5.1% (95% CI: 5.0%,5.1%) compared to 4.7% (4.6%,4.8%) in 2020 (p < 0.001). In contrast, men had no differences across the program weeks. For example, week 20 weight loss was 6.0% (5.9%,6.2%) in 2019 and 6.2% (6.0%,6.3%) (p = 0.15). In dichotomous analyses, women had a reduction in the percent that achieved at least 5% weight loss (19.6% vs 17.6%, p < 0.001) from 2019 to 2020, whereas men had not difference across the years (23.8% vs 24%, p = 0.6). Conclusions: Using an online, behavioral-based weight loss program, both genders had clinically meaningful weight loss during the COVID-19 period. And while there was statistically significant less weight loss in women during the COVID-19 time period, the clinical impact of this difference (0.4 kg) is questionable. Exploring the potential causes for the decrease in weight loss in women during the quarantine year are an important area of future analyses and work. We are currently cleaning the quality-of- life data to serve as the first place to start such analyses.
ABSTRACT
Objective: To assess the clinical course and outcomes of COVID-19 in patients with pre-existing neurologic disorders and the impact of COVID-19 on neurologic disorder during and after COVID-19. Background: In March of 2020, as COVID-19 increased in the United States, several risk factors for severe COVID-19 emerged, including age, hypertension, diabetes, and immunocompromised state. Neurologic disorders were not among these risk factors, and no information existed on the course and outcomes of COVID-19 in patients with various neurologic disorders. Design/Methods: After receiving IRB approval, a structured questionnaire was distributed via various media platforms between April-October 2020 to the US neurologists and neurology trainees with questions pertaining to their patients with pre-existing neurologic disorders who had COVID-19 infection confirmed either by SARS-Co-V2 PCR or IgG test. Results: Over a 6-month period, 66 patients, (age range 1-94, mean 49.2 years, 39 females, 27 males) were submitted, with most frequent neurologic disorders being chronic migraine (23%), epilepsy (12%) and multiple sclerosis (MS) (11%). Of these, 58% had a mild-to-moderate course of COVID-19 requiring no hospitalization, 41% required hospitalization or intensive care unit admission, and 5 patients died (2 were in their 90s with a history of stroke, 2 in their 60s with malignancy, and one 31-year-old male with MS.) COVID-19 resulted in exacerbation of the underlying neurologic disorder during or after COVID-19 in 57% of patients. Common persistent symptoms after COVID-19 included fatigue, exercise intolerance and headache. Conclusions: In this cohort, majority of patients with pre-existing neurologic disorders had a mild-to-moderate course of COVID-19 requiring no hospitalization, but many experienced exacerbation of their pre-existing neurologic disorder during or after COVID-19 and had persistent symptoms of fatigue, exercise intolerance and headache. Large prospective studies are needed to determine which neurologic disorders present a significant risk in order to protect the most vulnerable patient population.