ABSTRACT
Background: Recent studies have assessed the impact of the COVID-19 pandemic and related control measures on the number of new cancer diagnoses. The aim of this work was to evaluate the real impact of the lockdown on new cancer diagnoses in 2020. Material(s) and Method(s): To compare the incidence of tumors in 2020 with that in 2019, we used data collected by the Reggio Emilia Cancer Registry. We reported the variations (number of cases and% values) of all tumors and of the main sites by sex and period of lockdown. We calculated the standardized incidence and mortality rate of the last twenty years (2001-2020) for all tumor sites and the main sites (breast, colorectal, lung and prostate) by sex. Result(s): In 2020, 4,031 cases of cancer were recorded, 669 fewer than in 2019 (-14.2%). The sites that recorded the largest decline compared to 2019 were: skin (non-melanoma) (-281 cases), prostate (-110 cases), melanoma and bladder (-53 cases) and colorectal (-38 cases). The incidence trend in males decreased from 491.74 cases per 100,000 p/y in 2001 to 471.58 in 2019 and dropped to 386.59 in 2020. Mortality also decreased over the years from 250.8 cases per 100,000 p/y in 2001 to 164.4 cases in 2019 and 161.9 in 2020. In women, the incidence remained almost constant over the years, whereas there was a decline in mortality. The decrease in cancers recorded, especially during the lockdown, has been widely reported in the literature, but the data usually only cover the months leading up to September 2020. Conclusion(s): The COVID-19 pandemic has caused delays in the diagnosis of new cancers. However, it is necessary to document with data the real impact the pandemic has had on new diagnoses, taking into account the tumor site, gender, the presence of cancer screening, and in general the organization of healthcare of the territory in question.
ABSTRACT
Introduction: In patients with Multiple Sclerosis (pwMS) disease- modifying therapies (DMTs) are known to affect immune response to antigens and possibly to SARS-CoV2 vaccine. Therefore, post-vaccination serological assessments are needed to evaluate the effect of the vaccine on SARS-CoV-2 antibody response. Objectives and aims: We designed a prospective multicenter cohort study enrolling pwMS who were scheduled for SARSCov- 2 vaccination with mRNA vaccines (BNT162b2, Pfizer/ BioNTech, Inc or mRNA-1273, Moderna Tx, Inc) to evaluate their effect on SARS-CoV-2 antibody response. Methods: A blood collection for the measure of SARS-CoV-2 antibody before the first vaccine dose and 4 weeks after the second dose was planned, with a centralized and blinded serological assessment (electrochemiluminescence immunoassay, ECLIA, Roche Diagnostics). Results: Preliminary data were collected on 780 pwMS (76% BNT162b2 and 24% mRNA-1273) who had pre- and 4-week post-vaccination blood assessments. 87 (11.2%) were untreated, 154 (19.7%) on ocrelizumab, 25 (3.2%) on rituximab, 85 (10.9%) on fingolimod, 25 (3.2%) on cladribine and 404 (51.7%) on other DMTs. 677 patients (86.8%) had detectable post-vaccination SARS-CoV-2 antibodies. At multivariate analysis, the antibody levels of patients on ocrelizumab (178-fold decrease, p<0.001), fingolimod (26-fold decrease, p<0.001) and rituximab (17-fold decrease, p<0.001) were significantly reduced as compared to untreated patients. Vaccination with mRNA-1273 resulted in a systematically 3.5-fold higher antibody level than with the BNT162b2 vaccine (p<0.001). Interpretation: In pwMS, anti-CD20 treatment and fingolimod led to a reduced humoral response to mRNA-based SARS-CoV-2 vaccines. As mRNA-1273 elicits 3.5-higher antibody levels than BNT162b2, this vaccine may be preferentially considered for patients under anti-CD20 treatment or fingolimod. Combining our data with those that will be produced by studying the cellular immune response to vaccines, and including clinical follow-up, will contribute to better define the most appropriate SARS-CoV-2 vaccine strategies in the context of DMTs and MS. At the time of the ECTRIMS presentation data on the full sample (about 2000 subjects) will be presented.