Descriptive and retrospective analysis of diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the pandemic.

BACKGROUND: Little is known about diffuse glioma patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). METHODS: We performed a descriptive and retrospective analysis of 41 diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the COVID-19 pandemic. RESULTS: Confusion with or without fever was the most common neurological symptom (32%) supporting SARS-CoV2 testing in glioma patients with acute and unexplained confusion. Sixteen patients (39%) died after a median delay of 13 days. While multiple clinical, biological, and pathological features, COVID-19- or diffuse glioma-related, at hospital admission appeared to have a pejorative prognostic impact, none was significantly associated with death. Oncological treatments were interrupted at COVID-19 diagnosis and re-initiated with a median delay of 30 days after the end of COVID-19 symptoms. CONCLUSIONS: Interestingly, our retrospective study describes for the first time the characteristics of a cohort of diffuse glioma patients with symptomatic COVID-19. Diffuse glioma patients with poorly symptomatic COVID-19 did not come to the attention of physicians and were not enrolled in the study skewing the denominator for prognostic analysis. Further studies are warranted to specify prognosis of overall population of diffuse glioma patients with COVID-19, including asymptomatic patients, and interactions of prognostic factors of both COVID-19 and diffuse gliomas.

SARS-CoV-2 infection in patients with primary central nervous system lymphoma.

BACKGROUND: Cancer patients may be at higher risk for severe coronavirus infectious disease-19 (COVID-19); however, the outcome of Primary Central Nervous System Lymphoma (PCNSL) patients with SARS-CoV-2 infection has not been described yet. METHODS: We conducted a retrospective study within the Lymphomes Oculo-Cérébraux national network (LOC) to assess the clinical characteristics and outcome of SARS-CoV-2 infection in PCNSL patients (positive real-time polymerase chain reaction of nasopharyngeal swab or evocative lung computed tomography scan). We compared clinical characteristics between patients with severe (death and/or intensive care unit admission) and mild disease. RESULTS: Between March and May 2020, 13 PCNSL patients were diagnosed with SARS-CoV-2 infection, 11 (85%) of whom were undergoing chemotherapy at the time of infection. The mortality rate was 23% (3/13), and two additional patients (15%) required mechanical ventilation. Two patients (15%) had no COVID-19 symptoms. History of diabetes mellitus was more common in severe patients (3/5 vs 0/8, p = 0.03). Two patients recovered from COVID-19 after mechanical ventilation during more than two weeks and resumed chemotherapy. In all, chemotherapy was resumed after COVID-19 recovery in nine patients (69%) after a median delay of 16 days (range 3-32), none of whom developed unusual chemotherapy complication nor SARS-Cov2 reactivation. CONCLUSION: This preliminary analysis suggests that, while being at higher risk be for severe illness, PCNSL patients with COVID-19 might be treated maximally especially if they achieved oncological response at the time of SARS-CoV-2 infection. Chemotherapy might be resumed without prolonged delay in PCNSL patients with COVID-19.

Risk factors for Coronavirus Disease 2019 (COVID-19) severity and mortality among solid cancer patients and impact of the disease on anticancer treatment: A French nationwide cohort study (GCO-002 CACOVID-19).

BACKGROUND: Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. PATIENTS AND METHODS: In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and 11th June 2020. The primary end-point was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary end-points. RESULTS: From April 4 to 11th June 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18-2.52), The Eastern Cooperative Oncology Group Performance Scale (ECOG PS) ≥ 2 (OR 3.23, 95%CI: 2.27-4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01-1.16) and admission to ICU (OR 3.62, 95%CI 2.14-6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except for cytotoxic chemotherapy in the subgroup of patients with detectable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase polymerase chain reaction (RT-PCR), which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00-2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment (such as chemotherapy, targeted or immune therapy) interrupted or stopped following diagnosis of COVID-19. CONCLUSIONS: Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis.

The GCO-002 CACOVID-19 cohort: A French nationwide multicenter study of COVID-19 infected cancer patients and consequences on cancer management

Background: The novel COVID-19 outbreak spread rapidly around the world. Cancer patients (pts) consist of a highly vulnerable group due to underlying malignancy and/or treatment-induced immunosuppression. A high mortality rate from COVID-19 in cancer pts was previously reported. France is the fourth most affected country, with more than 150,000 infected individuals and over 28,000 deaths. GCO-002 CACOVID-19 study is a large French nationwide cohort of COVID-19 pts with solid tumors with the aim to identify risk factors of COVID-19 severity and evaluate impact on cancer treatment. Methods: Bispective multicenter cohort set up by the French Cooperative Groups in solid cancers: ANOCEF-IGCNO (CNS tumors), ARCAGY-GINECO (gynecological and breast cancers), FFCD (digestive cancers), GERCOR (digestive and other solid cancers), GORTEC/intergroupe ORL (head and neck cancers (H&N), and IFCT (thoracic cancers). French pts with solid cancers and COVID-19 diagnosed since 1 March 2020 were accrued. Exclusion criteria: pts treated curatively > 5 years ago. Results: From 6 April to 15 May 2020, 835 pts from 136 institutions (general hospitals 35%, university hospitals 35%, private centers 25%, cancer centers 5%) were registered. Men: 61%, median age: 69 years (20-100). Digestive cancers: 43% (16%/9% colorectal/pancreatic cancers), lung cancers: 22%, gynecological: 14%, (9% breast cancers), H&N: 10%, CNS: 4%, urologic cancers: 3%. Advanced or metastatic: 61%. Within 3 months before COVID-19 diagnosis, 69% of pts received a systemic anticancer treatment (chemotherapy, targeted or immune therapy) and 22% a local therapy (surgery, radiotherapy or local destruction). Diagnosis of COVID-19 was confirmed by RT-PCR, CT-scan or both in 91% or serology in 1.4%. COVID was treated in the same oncological center in 78%. During the follow-up period (mean 14 days), 208 (25%) pts died, including 173 (21%) COVID-19 related deaths. Conclusions: This first nationwide study of cancer pts with COVID-19 from France reports a high mortality rate. Updated and detailed data on anti-cancer treatments, risk factors of severe and fatal COVID-19 and impact of COVID-19 on cancer management will be presented. Legal entity responsible for the study: Fédération Francophone de Cancérologie Digestive. Funding: Has not received any funding. Disclosure: A. Lièvre: Honoraria (self), Advisory/Consultancy: AAA;Amgen, Pierre Fabre;Sandoz;Honoraria (self), Advisory/Consultancy, Research grant/Funding (self), Travel/Accommodation/Expenses: Bayer;Novartis;Honoraria (self): Celgene;HalioDx;Lilly;Honoraria (self), Travel/Accommodation/Expenses: BMS;Roche;Honoraria (self), Research grant/Funding (self): Incyte;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Ipsen;Merck;Servier;Research grant/Funding (self): Integragen;Travel/Accommodation/Expenses: AAA;Pfizer. A. Turpin: Honoraria (self): Servier;Advisory/Consultancy: Mylan;Merck Serono;Amgen;Travel/Accommodation/Expenses: Merck;Sanofi;Pfizer;AstraZeneca. I.L. Ray-Coquard: Honoraria (self), Advisory/Consultancy: Abbvie;Agenus;Advaxis;Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Research grant/Funding (institution): BMS;MSD;Honoraria (self), Advisory/Consultancy: PharmaMar;Genmab;Pfizer;Deciphera;Mersena;Amgen;Tesaro;Clovis;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Merck Serono;Novartis;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca;Honoraria (self), Honoraria (institution), Advisory/Consultancy, Research grant/Funding (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche;Honoraria (self), Honoraria (institution), Advisory/Consultancy, Travel/Accommodation/Expenses: GSK;Non-remunerated activity/ies: GINECO;ENGOT;GCIG;European community;ESMO;ASCO;ESGO;IGSC;Inca;Swiss and German Health Authorities;Italian Health Authority;Belgium Health Authority. J. Thariat: Honoraria (self): BMS;Honoraria (institution), Travel/Accommodation/Expenses, Full/Part-time employment: Centre François Baclesse;Leadership role: President of the French Head and Neck Intergroup, GORTEC secretary;Non-remunerated activity/ies: Director of Easy-CRF society;Research grant/Funding (institution): Nanobiotix. G. Ahle: Travel/Accommodation/Expenses: Abbvie;Biogen;Novartis;Roche;Sanofi;Non-remunerated activity/ies: ANOCEF;NENO;AlSacEP. R. Mathieu: Honoraria (self), Research grant/Funding (self): Astellas;Honoraria (self): AstraZeneca;Ferring;Ipsen;Janssen;MSD;Pfizer;Sanofi;Takeda. D. Debieuvre: Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Pfizer;Roche;Novartis;BMS;MSD;Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca;Honoraria (self), Research grant/Funding (institution): Chugaï;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Boerhinger-Ingelheim;Research grant/Funding (institution): Chiesi;Sandoz;Takeda;GSK;Research grant/Funding (self): Lilly. A. Canellas: Honoraria (self), Advisory/Consultancy: BMS;Honoraria (self), Travel/Accommodation/Expenses: AstraZeneca;Travel/Accommodation/Expenses: Oxyvie;LVL Medical;Boerhinger Ingelheim. A-C. Hardy-Bessard: Advisory/Consultancy: Clovis;Novartis;Roche;MSD;AstraZeneca;GSK. L. Mansi: Honoraria (institution), Advisory/Consultancy: Sandoz;Advisory/Consultancy: Roche;Eisai;Pfizer;Novartis;Speaker Bureau/Expert testimony: Exact Sciences;Travel/Accommodation/Expenses: Lilly. P. Gorphe: Honoraria (self): Intuitive Surgical;Non-remunerated activity/ies: Chair, scientific board, French Head and Neck Intergroup;Research grant/Funding (institution): MSD. A. IDBAIH Ahmed: Research grant/Funding (institution): Transgene;Sanofi;Air Liquide;Travel/Accommodation/Expenses: Carthera;Leo Pharma. G. Zalcman: Honoraria (self), Honoraria (institution), Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS;Honoraria (self), Honoraria (institution), Travel/Accommodation/Expenses: AstraZeneca;Honoraria (institution), Research grant/Funding (institution), Travel/Accommodation/Expenses: Roche;Honoraria (institution): Takeda;Travel/Accommodation/Expenses: Pfizer;AbbVie;MSD. O. Bouche: Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Honoraria (self), Advisory/Consultancy: Merck KgaA;Bayer;AstraZeneca;Grunenthal;MSD;Honoraria (self), Speaker Bureau/Expert testimony: Amgen;Pierre Fabre;Honoraria (self), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Servier. All other authors have declared no conflicts of interest.

A review of the international early recommendations for departments organization and cancer management priorities during the global COVID-19 pandemic: applicability in low- and middle-income countries.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer. Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints.