Seroconversion rate after vaccination against COVID-19 in patients with cancer-a systematic review.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected >210 million people worldwide. An optimal therapeutic approach for COVID-19 remains uncertain, to date. Since the history of cancer was linked to higher mortality rates due to COVID-19, the establishment of a safe and effective vaccine coverage is crucial in these patients. However, patients with cancer (PsC) were mostly excluded from vaccine candidates' clinical trials. This systematic review aims to investigate the current available evidence about the immunogenicity of COVID-19 vaccines in PsC. PATIENTS AND METHODS: All prospective studies that evaluated the safety and efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included, with immunogenicity after the first and the second dose as the primary endpoint, when available. RESULTS: Vaccination against COVID-19 for PsC seems overall safe and immunogenic after well-conducted vaccination schedules. Yet the seroconversion rate remains lower, lagged or both compared to the general population. Patients with hematologic malignancies, especially those receiving B-cell-depleting agents in the past 12 months, are the most at risk of poor seroconversion. CONCLUSION: A tailored approach to vaccination may be proposed to PsC, especially on the basis of the type of malignancy and of the specific oncologic treatments received.

Impact of COVID-19 on ongoing oncological and hematological treatment strategy

Background: Outcomes and risk factors associated with COVID-19 worsening among cancer patients have previously been reported. However, the actual impact of SARs-Co-V2 infection on the cancer treatment strategy remains unknown. Here, we report the Gustave Roussy (GR) experience, one year after the onset of the pandemic focusing on the impact of COVID-19 in patients with ongoing management of oncohematological disease. Methods: All patients positively tested for SARS-CoV-2 and managed at GR between Mar 14th 2020 and Feb 15th 2021 (data cut-off) have been included. Patients underlying oncohematological disease and COVID19 characteristics have been collected. Cancer and COVID-19 management and outcomes have been assessed. Primary endpoint was the overall impact of COVID-19 on oncological and hematological treatment strategy assessed at 1, 3, 6 and 12 months. Results: At the time of the analysis, 423 patients (median age: 62 years) were found positive for SARS-CoV-2 and managed at GR with a median follow up of 5.6 months (0-13 months). Among them, 284 (67%) were admitted due to COVID-19. Clinical deterioration occurred in 87 patients (21%), 43 patients (10%) were transferred in intensive care unit and 123 (29%) patients died, among which 47 (11%) died from COVID-19. Overall, 329 (78%) patients were on active treatment for underlying oncohematological disease at time of COVID diagnosis. Impact of COVID-19 on cancer treatment strategy in those patients is presented in the Table. The majority (N=268, 81%) had no change in oncological strategy. For those who experienced a delay, median delay in treatment was 21 days (N=99, [1-77]), 30 days (N=15, [15-56]), 7 days (N=8,[3-35]) for systemic treatment, surgery and radiotherapy respectively. [Formula presented] Conclusions: COVID-19 outbreak is associated with a significant mortality in patients with cancer. However, for patients who did not die from COVID-19, we provide the first report supporting that ongoing treatment was maintained or could be resumed in the majority of cases in a timely manner. Legal entity responsible for the study: Gustave Roussy. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

1451P An onco-palliative expertise unit in a French comprehensive cancer center: Experience at 2 years

Background: The implementing of an Onco-Palliative Expertise Unit (OPEU) in a large Comprehensive Cancer Center (CCC), responds to a need to develop advanced care planning and to integrate palliative care into a shared care project. Methods: Our 10-bed unit opened on March 1, 2019. Its aim is to provide enhanced care for complex patients and to facilitate decision-making in advanced palliative care. The main goal of hospitalizations in this OPEU is to rethink the therapeutic project with oncologists, patients and their families and take care of refractory symptoms. Results: Two years after opening, our unit has received 522 pts, mean age 58 years (24-94), in 666 stays. 50% came from the home. 81,5% of patients were PS ≥3 and 89% in metastatic stage. Almost half of them were already followed by the palliative care team. After an average length of stay of 10.7 days (median 9 days), discharge was distributed between return home (38%), a palliative care unit (22%), death (26%) and other oncology units, or hospitals (14%). At the opening, refractory symptoms were the most frequent reason for hospitalization (67% of stays). For the first 6 months period to the second one, discussing the therapeutic project increased from 23% to 34% of the hospitalization causes, showing the appropriation of this unit by the oncologists. On admission, specific cancer treatment was ongoing for 54% of stays. After assessment and multidisciplinary discussion, 49,6% of them decided to stop chemotherapy. Conversely, the start or resumption of treatment was recommended for 12,8% of stays without specific treatment on admission. Comparing the first and second year of opening, the objectives stays and characteristics of the patients remain stable, apart from the deaths in the unit which have increased, probably partly explained by the COVID-19 pandemic. Conclusions: The creation of an OPEU in a CCC allows getting around the taboo of palliative care. It supports the dialogue between the oncologist and the pt, allows the pt to make the therapeutic project evolve toward a life project, avoiding costly unreasonable obstinacy. After 2 years, our unit has proved its usefulness but it would be interesting to evaluate the satisfaction and opinion of oncologists. We also have plans now to develop clinical research in the unit. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Outcome of older cancer patientsinfected with Covid19 at Gustave Roussy Cancer Center

Background: The SARS-CoV-2 outbreak in Paris's region significantly affected Gustave Roussy Cancer Center.Previous analyses showed that mortality rate increases with age in the general population. Here, we report theGustave Roussy experience on older patients (OP) with cancer during the SARS-CoV-2 outbreak. Methods: Cancer pts with suspected SARS-CoV-2 infection were admitted at Gustave Roussy starting March 12th.Screening indications have been adapted over the time. All the COVID19 pts positively tested and managed atGustave Roussy between March 14th (1st positive case) and April 15th have been included in a REDCap database.Pts and underlying oncologic and COVID19 diseases characteristics have been collected. Cancer and COVID-19managements and outcomes have been assessed. The primary endpoint of this analysis was the clinicaldeterioration, defined as the need for O2 supplementation of 6l/min, or death of any cause. Results: Among the first 137 cancer pts diagnosed with SARS-CoV-2, 36 patients were aged 70 years (26%). Mostof them were female (61%) with a median age of 75.5 years old. Most frequent underlying cancers were solidtumors (92%) including GI (19%), lung (17%), GYN (14%), and head and neck (14%). Most OP (36%) were ECOGperformance status 2 versus 24% in younger patients (YP). The diagnosis of SARS-CoV-2 infection was made byRT-PCR or thoracic CT scan alone in 97% and 3% of the cases, respectively, in OP and in 92% and 8% in YP. MostOP experienced symptoms prior to testing (92%) compared to YP (80%). Symptoms differed according to age withmore cough with sputum production in OP (14% versus 5%), dyspnea (39% versus 31%), diarrhea (17% versus9%), shivers (8% versus 0%), sore throat (8% versus 4%), and no anosmia or agueusia. The majority of OP werehospitalized (81%) compared to 72% of YP and treated with HCQ/AZI (15;52%) with inclusion in the ONCOVID trial(EudraCT: 2020-01250-21) compared to 25 (35%) YP. They did not receive any IL-6 inhibitor. Only one OP wasadmitted in the ICU (3%). Clinical deterioration occurred in 10 OP (29%). There was no impact of age on clinicalworsening (HR=1.157;95%CI 0.55-2.42;p=0.7). However, age was associated with worse overall survival (OS)(HR=2.45 95%CI 1.02-5.92 ;p=0.0463). Results will be updated at the meeting. Conclusions: OP with cancer had a different disease presentation, same rate of clinical worsening, but worse OSin SARS-CoV-2 infection.

Value of nurse navigators (NNs) telemonitoring for cancer patients (pts) tested positive for COVID-19

Background: The current COVID-19 pandemic has raised a major challenge to healthcare systems. Deployment of telehealth solutions can help maintaining continuity of care while limiting pts' and healthcare workers’ exposure with the virus. In this context, Gustave Roussy Cancer Institute has implemented a pts reported outcome platform (CAPRI-COVID) to improve monitoring and effective management of COVID-19 positive pts with cancer. Methods: CAPRI-COVID consists in a mobile application (CAPRI App) and a telephone platform with a dedicated call number, the entire procedure being managed by four NNs. After an initial assessment by the NNs, remote monitoring of 6 COVID-related symptoms were collected daily, either by the patient via the CAPRI App or by NNs during a phone call. In case of worsening or emerging symptoms, an automated alert was sent to the platform;NN assessed the clinical condition and could ask for a medical advice if necessary. The monitoring period was 14 days (with at least 2 days with complete regression of symptoms). Each intervention performed by NNs was tracked on the platform, as well as pts-reported data. This analysis presents the data collected via the platform from March 23 to May 4 2020. Results: Overall, 116 COVID-positive pts have completed the monitoring period (median age: 58.5 years, 21-90;56.9% female). 54.3% were monitored after hospitalization for COVID-19, 37.1% after RT-PCR screening (symptomatic pts) and 8.6% for systematic screening prior to surgery. There were no deaths or admissions to intensive care unit. 7.8% of pts were hospitalized (excluding scheduled hospitalization). NNs conducted an average of 9.9 calls per patient. Of 53 events requiring a medical opinion, 50.9% resulted in a visit to the emergency room. 41.4% of pts downloaded the CAPRI App, and completed the tracking data on average 1.1 times per day. Conclusions: CAPRI-COVID enabled to keep the majority of pts at home, and helped to ensure secure pts’ pathways during this epidemic. NNs play an essential role in addition with the use of CAPRI App which helped limiting phone calls and focusing on the management of complex pts. Ongoing analyses are exploring actions of NNs and pts’ experience. Legal entity responsible for the study: Gustave Roussy. Funding: Has not received any funding. Disclosure: O. Mir: Honoraria (self), Travel/Accommodation/Expenses: Amgen;Honoraria (self), Honoraria (institution): AstraZeneca;Honoraria (self), Research grant/Funding (institution): Bayer;Honoraria (institution), Advisory/Consultancy, Research grant/Funding (institution): Blueprint Medicines;Honoraria (self): Bristol-Myers Squibb;Honoraria (self), Speaker Bureau/Expert testimony, Research grant/Funding (institution): Eli Lilly;Honoraria (self), Honoraria (institution), Advisory/Consultancy, Shareholder/Stockholder/Stock options: Ipsen;Honoraria (self): Lundbeck;Honoraria (self): MSD;Honoraria (self), Honoraria (institution): Novartis;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Pfizer;Honoraria (self), Honoraria (institution), Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Honoraria (self), Speaker Bureau/Expert testimony: Servier;Honoraria (self): Vifor Pharma;Shareholder/Stockholder/Stock options: Amplitude Surgical;Honoraria (self), Shareholder/Stockholder/Stock options: Transgene;Honoraria (institution): PharmaMar. F. Scotté: Honoraria (self): CIO Roche;Honoraria (self): MSD;Honoraria (self): Pierre fabre Oncology;Honoraria (self): Leo Pharma;Honoraria (self): BMS;Honoraria (self): Pfizer;Honoraria (self): Mundi Pharma;Honoraria (self): Mylan. All other authors have declared no conflicts of interest.

Outcome of older cancer patients infected with COVID-19 at Gustave Roussy Cancer Center

Background: The SARS-CoV-2 outbreak significantly affected Gustave Roussy cancer center. Here, we report the Gustave Roussy experience on older patients (OP) with cancer during the SARS-CoV-2 outbreak. Methods: Cancer pts with suspected SARS-CoV-2 infection were admitted at Gustave Roussy starting March, 12th. Screening indications have been adapted over time. All the COVID-19 pts positively tested and managed at Gustave Roussy between March 14th and April 15th have been included in a redcap database. Pts and underlying oncological and COVID-19 diseases characteristics have been collected. Cancer and COVID-19 managements, and outcomes have been assessed. The primary endpoint of this analysis was the clinical deterioration, defined as the need for O2 supplementation of 6l/min or more, or death of any cause. Results: Among the first 137 cancer pts diagnosed with SARS-CoV-2, 36 patients were aged 70 years old or over (26%). Most of them were female (61%) with a median age of 75.5 years old. Most frequent underlying cancers were solid tumors (92%) including GI (19%), lung (17%), GYN (14%) and head and neck (14%). Most OP (36%) were ECOG Performans status 2 versus 24% in younger patients (YP). The diagnosis of SARS-CoV-2 infection was made by RT-PCR or thoracic CT scan alone in 97% and 3% of the cases, respectively in OP and in 92% and 8% in YP. Most OP experienced symptoms prior to testing (92%) compared to YP (80%). Symptoms differed according to age with more cough with sputum production in OP (14% versus 5%), dyspnea (39% versus 31%), diarrhea (17% versus 9%), shivers (8% versus 0%), sore throat (8% versus 4%) and no anosmia nor agueusia. The majority of OP was hospitalized (81%) compared to 72% of YP and treated with HCQ/AZI (15;52%) compared to 25 (35%) YP with inclusion in the ONCOVID trial (EudraCT: 2020-01250-21). They did not receive any IL-6 inhibitor. Only one OP was admitted in the ICU (3%). Clinical deterioration occurred in 10 OP (29%). There was no impact of age on clinical worsening (HR=1.157;95%CI 0.55-2.42;p=0.7). However age was associated with worse overall survival (OS) (HR=2.45 95%CI 1.02-5.92;p=0.0463). Results will be updated at the meeting. Conclusions: OP with cancer had a different disease presentation, same rate of clinical worsening but worse OS in SARS-CoV-2 infection. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Supportive Care: An Indispensable Component of Modern Oncology.

The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as 'the prevention and management of the adverse effects of cancer and its treatment'. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.