ABSTRACT
Introduction: Covid-19 pandemic has drastically changed the management of patients with cancer;however, there is still limited data regarding the real impact of Covid-19 on patient’s outcomes due to delayed diagnosis and treatment of clinical complications. We aimed to assess the prevalence, severity and mortality of clinical complications and oncology emergencies in hospitalized patients in our institution during the Covid19 period vs. the same period of 2019. Methods: We conducted a retrospective study of patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) who were admitted to the Department of Medical Oncology during Jan-Jun 2019 (before-Covid) and Jan-Jun 2020 (Covid-19 period). Clinical, pathological and biological data were collected. We assessed the clinical severity in both periods including: PS at admission, progression disease (PD), oncologic emergencies (%), start of a systemic therapy or switch to other therapy line. We also analyzed the differences on the 30-day mortality rate since hospitalization between both periods. Results: 229 admissions, 133 during and 93 before Covid-19 pandemic (N=180 patients) were enrolled;the median duration of the hospitalization was 9 days (4-16). Median age was 66 years, 35% were female, 88% with PS≥2, 27% were current smokers;83% had NSCLC histology. Most of them (82%) had advanced disease at admission;69% were under systemic therapy (chemotherapy 39%, immunotherapy 17%, targeted therapies 11%). Nine patients (4%) were active covid-19 cases (9 NSCLC, 0 SCLC). The table 1 summarized the most common clinical conditions by histology, in both periods. In NSCLC population, during-Covid, lower rate of admissions were observed (4 cases less per month), with no increase of oncologic emergencies. The PD during hospitalization was slightly higher during vs. before-Covid, but no differences were observed in 30-days mortality rate. In SCLC population, during-Covid, the rate of admissions was doubled (2 cases more per month), with more cases progressing during the hospitalization. (46% during vs. 34% before-Covid). In contrast to NSCLC, the 30-days mortality rate was higher during-Covid (38%) vs. before-Covid (20%). Updated data will be presented in the meeting. [Formula presented] Conclusion: We preliminary observed more aggressive disease with worse outcomes in patients with SCLC hospitalized during-Covid compared to the same period in 2019. No differences were observed in NSCLC. The final outcomes will be assessed in a larger and mature cohort still ongoing. Keywords: lung cancer, COVID-19, hospitalization
ABSTRACT
Background: Inflammation plays a central role in severe COVID-19 disease. Likewise, in cancer patients (pts), a circulating pro-inflammatory status (proinflam-status) is associated with poor outcomes. We aimed to assess if a proinflam-status induced by cancer can negatively impact on COVID-19 outcomes. Methods: Multicenter retrospective cohort of cancer pts with SARS-CoV-2 infection across 12 international centers. Circulating inflammatory markers were collected at two timepoints: pre-COVID condition (-15 to -45d before COVID-19 diagnosis) and COVID-19 diagnosis. Tumor-induced proinflam-status was defined by high derived neutrophil to lymphocyte ratio (dNLR>3) at pre-COVID condition. COVID-induced proinflam-status was defined by +100% increase of dNLR between both timepoints. We built the FLARE score, combining both Tumor and Infection-induced inflammation: T+/I+ (poor), if both proinflam-status;T+/I- (T-only), if inflammation only due to tumor;T-/I+ (I-only), if inflammation only due to COVID;and T-/I- (favorable), if no inflam-status. Primary endpoint was 30-day mortality. Results: 287 pts were enrolled with a median follow-up of 23d [95%CI 22-26]. Median age was 69 (range 35-98), 52% were male and 49% had hypertension. As per cancer characteristics: 68% had active disease, 52% advanced stage and 79% had a baseline PS≤1. Thoracic cancers were the most common (26%) and 61% of pts were under systemic therapy. The dNLR was high in 24% at pre-COVID condition vs. 55% at COVID-19 diagnosis. Median change between both timepoints was +67% (IQR: 0% to +153%);40% had +100% increase of dNLR. Pts distribution across FLARE groups were: 5% in poor (n=9), 20% in T-only (n=39), 35% in I-only (n=69) and 40% in favorable (n=80). Overall mortality rate was 27%. According to FLARE score: 67% mortality for poor vs. 35% for I-only vs. 33% for T-only vs. 19% in favorable group (p=0.008). The FLARE poor group was independently associated with 30-day mortality [OR 5.7;1.02-31.2]. Conclusions: Both tumor and infection-induced proinflam-status impact on COVID-19 outcomes in cancer pts. The FLARE score, based on simple dynamics between two timepoints, allows to identify the population at higher risk for early death. Legal entity responsible for the study: Aleix Prat. Funding: Has not received any funding. Disclosure: E. Auclin: Travel/Accommodation/Expenses: Mundipharma;Speaker Bureau/Expert testimony: Sanofi Genzymes. S. Pilotto: Speaker Bureau/Expert testimony: AstraZeneca;Eli-Lilly;BMS;Boehringer Ingelheim;MSD;Roche. A. Prat: Honoraria (institution), Speaker Bureau/Expert testimony: Roche;Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer;Novartis;Amgen;Speaker Bureau/Expert testimony: BMS;Honoraria (institution), Speaker Bureau/Expert testimony: Daiichi Sankyo;Nanostring technologies;Advisory/Consultancy: Puma;Oncolytics Biotech;MSD;Honoraria (institution), Advisory/Consultancy: Lilly;Honoraria (institution): Boehringer;Sysmex Europa GmbH;Medica Scientia inno. Research;Celgene;Astellas Pharma;Officer/Board of Directors: Breast International Group;Solti's Foundation;Leadership role: Actitud Frente al Cancer Foundation. L. Mezquita: Speaker Bureau/Expert testimony, Research grant/Funding (self), Travel/Accommodation/Expenses: Bristol-Myers Squibb;Speaker Bureau/Expert testimony: Tecnofarma;Speaker Bureau/Expert testimony, Non-remunerated activity/ies: AstraZeneca;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Research grant/Funding (self): Boehringer Ingelheim. All other authors have declared no conflicts of interest.