A one-year survey on cancer patients affected by SARSCoV-2 infection: Clinical characteristics and disease evolution in a single Institution experience

Background: Patients affected by cancer are considered particularly susceptible to SARS-CoV-2 infection complications. We aimed to study the effect of COVID on patients with solid tumors at our Oncology Unit at Policlinico San Matteo of Pavia. Material and methods: Data of patients affected by solid tumors and COVID-19 were extracted from medical records between February 21, 2020 and May 15, 2021. COVID diagnosis was confirmed by RT-PCR on nasal swab. Associations between demographic, clinical characteristics and outcomes were measured with HR with 95%CI using Cox regression. Results: Seventy-five patients affected by solid tumors with COVID diagnosis were included in the analysis. The incidence of SARS-CoV-2 infection in our cancer patients was similar to that observed in the global Italian population (5.8 vs 6.2%), but lower compared to the local population of Lombardia (8.2%) and Pavia (7.9%). In 34 patients (45.9%) COVID diagnosis was obtained through screening, in 40 patients (54.1%) because of symptoms or radiologic findings. Median age was 64.4 years (25th-75th 56-75);the majority had an ECOG PS of 0-1 (89.2%), was affected by breast, lung or gastro-intestinal cancer (28.0, 26.7 and 21.3% respectively), had stage IV disease (72.2%) and was on therapy at the time of COVID (76.0%);26 patients (36.1%) were hospitalized;21 patients (28.0%) died, 13 of them (17.3%) for COVID complications. COVID determined a median delay of the oncologic treatment of 14.0 days (25th-75th 0-25). Mortality rate was higher in our cancer population than that observed in the global Italian population (3.0%), in local population of Lombardia (4.0%) and Pavia (5.9%). In the univariable analysis, being older than 66 years (HR: 2.64, 95%CI 1.06-6.55, p=0.029), with ECOG PS ≥ 2 (HR: 5.81, 95%CI 2.18-15.49, p=0.002), >1 comorbidities (HR: 2.72, 95%CI 1.14-6.48, p=0.023), having dyspnea at the time of COVID diagnosis (HR: 6.10, 95%CI 2.37-15.68, p=0.0001), and being hospitalized (HR: 6.75, 95%CI 3.06-36.89, p<0.001) were associated with increased risk of death. In multivariable analysis, ECOG PS ≥ 2, dyspnea, hospitalization and days of treatment delay were associated with increased risk of death. Conclusions: The incidence of SARS-CoV-2 infection in our cancer patients was lower than that observed in the local population of Lombardia and Pavia, while mortality rate was higher. Predictive factors of death in cancer population correlate consistently with those alrealy published about global population.

A snapshot of the immunogenicity, efficacy and safety of a full course of BNT162b2 anti-SARS-CoV-2 vaccine in cancer patients treated with PD-1/PD-L1 inhibitors: a longitudinal cohort study.

BACKGROUND: Very few cancer patients were enrolled in coronavirus disease-2019 vaccine studies. In order to address this gap of knowledge, real-world studies are mandatory. The aim of this study was to assess both humoral and cellular response after a messenger RNA vaccination schedule. PATIENTS AND METHODS: Eighty-eight consecutive cancer patients treated with programmed cell death protein 1/programmed death-ligand 1 inhibitors were enrolled from the beginning of the vaccination campaign for frail patients. Blood samples for humoral and cell-mediated immune response evaluation were obtained before vaccination (T0), before the second administration (T1) and 21 days after the second dose (T2). The primary endpoint was the evaluation of the percentage of participants showing a significant increase in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cells, measured by an enzyme-linked immunospot assay, after the second dose of BNT162b2 vaccine. The proportion of patients who reached the primary endpoint is computed together with its exact binomial 95% confidence interval. RESULTS: In SARS-CoV-2-naïve subjects, spike-specific T-cell response was almost undetectable at T0 [median 0.0 interferon-γ (IFN-γ) spot forming units (SFU)/million peripheral blood mononuclear cell (PBMC) interquartile range (IQR) 0-7.5] and significantly increased at T1 and T2 (median 15.0 IFN-γ SFU/million PBMC, 25th-75th 0-40 versus 90 IFN-γ SFU/million PBMC, 25th-75th 32.5-224, respectively) (P < 0.001). Focusing on naïve and experienced SARS-CoV-2 subjects, no differences were reported both in terms of CD4- and CD8-specific T-cell response, suggesting that BNT162b2 is able to elicit both adaptive responses after complete vaccination schedule, regardless of previous SARS-CoV-2 exposure. The level of SARS-CoV-2 neutralizing antibodies was low at T1 in SARS-CoV-2-naïve subjects [median 1 : 5 (IQR 1 : 5-1 : 20)] but reached a significantly higher median of 1 : 80 (25th-75th 1 : 20-1 : 160) at T2 (P < 0.0001). Moreover, no COVID-19 cases were documented throughout the period of study. CONCLUSIONS: Our data have demonstrated that the administration of a full course of BNT162b2 vaccine elicited a sustained immune response against SARS-CoV-2 regardless of the type of cancer and/or the type of immune checkpoint inhibitors.

A multidisciplinary multicenter study evaluating risk factors, prevalence and characteristics of post-COVID-19 interstitial lung syndrome pcoils

Backgrounds: Available data indicate that a large minority of patients with COVID-19 develop ARDS, and pulmonary fibrosis is a recognized sequela of ARDS. However, the long-term pulmonary consequences of COVID-19 remain speculative. The aim of this study is to evaluate risk factors, prevalence and characteristics of POST-COVID-19 interstitial lung changes, with the unique opportunity to evaluate radiologic and pathologic correlations using HRCT and transbronchial lung cryobiopsy specimens.Methods: Here we present the preliminary data on HRCT features of POST-COVID-19 ILD. Data were collected at the time of the first interim analysis (28/11/2020) of the PCOILS trial: a prospective, multicenter national study involving 12 Italian centers (Fig 1). We collected data of consecutively hospitalized patients at baseline and then at 6 (+/-1) months after hospital discharge. HRCT changes at 6 months involving more than 5% of the total lung volume were considered significant. Patients with significant HRCT changes will undergo BAL and/or cryobiopsy and a subsequent follow-up with HRCT and lung function evaluation at 12(+/-1) and 18 (+/-1) months.Results: At the time of the present interim analysis, 524 patients from 9 centers were enrolled (enrollment is still ongoing and will end on January 31st, 2021). Median age was 67 years (range 18-87), 330 were males (62.9%). HRCT changes were detected in 333 participants (63.5%), and in 219 (41.7%) were considered significant. 118 cases (22.5%) showed fibrotic changes including the following HRCT patterns: 7 (1.3%) probable UIP, 45 (8.5%) NSIP (with or without OP), 38 (7.2%) indeterminate, 28 (5.3%) fibrotic consolidations. Among the remaining 101 (19.2%) non fibrotic cases the radiologists described: 11 (2%) NSIP-OP, 15 (2.8%) indeterminate, 67 (12.7%) pure ground glass, 8 (1.5%) consolidations all suspected for lung cancer. Conclusions: This preliminary analysis confirms that after COVID-19 infection a large minority of patients develops interstitial lung changes mostly with NSIP-OP, indeterminate features or ground glass. The hypothesis that post-COVID-19 interstitial changes and interstitial lung diseases may share common risk factors, pathogenetic mechanisms and disease behaviour warrants further evaluations. .