ABSTRACT
Purpose or Objective It has been shown that the COVID-19 pandemic during 2020 has prompted the quality of cancer care, as it induced more cases of late diagnosis of many cancers, in particular HN cancer. As consequence, these delays in diagnosis and treatment initiation may impact the prognosis. Aim of this study is to analyse features of the pts treated for an HN cancer in 2020 during the COVID-19 in our RO department, and to compare these patients with those treated in 2019, in order to highlight differences in staging and prognosis. Materials and Methods We analysed the electronic charts of patients addressed for curative RT-CT to our Dpt for a HN cancer in 2019 and in 2020. We performed a descriptive analysis for demographics and staging and we compared pts using a two-tailed Fisher's exact test. The chi-square test was used to compare the distribution of the clinical features of the patients. A p-value of >0.05 was considered as statistically significant. Results A total of 48 pts were addressed to our Department, 21 in 2019 and 27 in 2020. Median age was 63.6 years (38 - 88) in 2019 and 60.3 (30-78) years in 2020 (p-value = NS) Table 1 summarized data of the pts. Patients features 2019 2020 p-value (Chi square test) Male/Female ratio 19/2 22/5 NS P16 status (positive/negative/NA) 7/3/11 6/10/11 NS T stage distribution (T1/T2/T3/T4) 4/6/4/7 3/4/5/15 NS N stage distribution (N0/N1/N2/N3) 9/4/6/2 7/5/12/2 NS TNM stage (I/II/III/IV) 3/7/3/8 3/2/6/16 NS We found significantly more pts with advanced diseases (stage III-IV) in 2020 when compared to 2019 (22 vs 11), in particular because of a higher number of T4 tumors (15 vs 7) and N2 tumors (12 vs 6) in patients treated in 2020. The small samples of our populationn could explain the lack of significativity. Fig 1 shows the 2X2 contingency table for the Ficher's exact test. $Φg Conclusion In our analysis, pts addressed to our Dpt for a HN cancer in 2020 presented more advanced stages when compared to 2019. The follow-up of pts was too short to present data on LC and OS in this abstract, but clinical data will be presented during the congress.
ABSTRACT
Background: The management of rheumatoid arthritis refractory to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) is currently well codified and includes different types of biologics and even targeted sDMARDs. A rotation of biologic therapies is recommended in order to better control the disease. Methods: We report the case of a 20-year-old patient followed in our hospital for the management of a deforming and erosive seropositive rheumatoid arthritis (FR +, ACPA +) with a juvenile onset at the age of 8 years. The diagnosis of an immunopositive polyarticular form of JIA was retained in 2010 (9 years old);the patient was treated with methotrexate (MTX) at a dose of 10 mg per week and methylprednisolone at doses varying between 4 and 10 mg per day. Following the failure of MTX, etanercept was introduced for 6 months without success, followed by tocilizumab in 2012 at a dose of 8mg/kg/month for a year, without good response. In 2014, a course of rituximab (RTX) at a dose of 2 shots of 500mg, 2 weeks apart was prescribed followed 9 months later by etanercept at a dose of 50 mg a week for 3 years then by adalimumab (40mg/ week) because of the multiple treatment failures. In 2018, the repetition of RTX at a dose of 1g, renewed 15 days later, improved the patient for only 3 months. Then, a combination of two biologics, namely RTX (2 x 1g, 15 days apart) and adalimumab 1 month later (40mg / week) was received by the patient with a good response at 3 months. The latter was maintained for 7 months even after stopping the adalimumab following confinement for COVID-19. In September 2020, flares occurred and the adalimumab (ADA) has been delivered but without success during 3 months, stopped later for a benign form of COVID-19 (15 months after RTX). In January 2021, the association RTX + ADA was given again and we hope that it will be as effective as the first prescription. Results: The clinical and biological severity of our patient's rheumatoid arthritis led us to give a combination of two biological treatments. Indeed, we do not have other therapeutic classes to deliver to her, that encouraged us to rotate between all the available biological therapies in our country. The combination of a CD20 inhibitor (RTX) with a TNF blocker (ADA) was safe and made possible, for the first time, the achievement of clinical and biological remission during 7 months, even after stopping the TNF blocker. Greenwald et al. reported the safety of the combination of RTX + TNF inhibitors in a randomized clinical trial in 51 patients. Its efficacy, a secondary goal of the study, was suggested at 24 weeks by the percentage of ACR 20 and ACR 50 responses that was greater than in the RTX placebo group. Conclusion: The combination of RTX with a TNF blocker can be a real alternative therapy in rheumatoid arthritis with failure to a biological monotherapy.