ABSTRACT
There is a pressing need to characterise the nature, extent and duration of immune response to SARS-CoV-2 in cancer patients, to inform risk-reduction strategies and preserve cancer outcomes. CAPTURE is a prospective, longitudinal cohort study of cancer patients and healthcare workers (HCWs) integrating immune profiles and clinical annotation. We evaluated 529 blood samples and 1051 oronasopharyngeal swabs from 144 cancer patients and 73 HCWs and correlated with >200 clinical variables. In patients with solid cancers and HCWs, S1-reactive and neutralising antibodies to SARS-CoV-2 were detectable five months post-infection. In these participants, SARS-CoV-2-specific T-cell responses were detected. CD4+ T-cell response correlated with S1 antibody levels. Patients with haematological malignancies had impaired but partially compensated immune responses, depending on malignancy and therapy. Overall, cancer stage, disease status, and therapies did not correlate with immune responses. These findings have implications for understanding individual risks and potential effectiveness of SARS-CoV-2 vaccination in this population.
ABSTRACT
Background: Globally, United Kingdom (UK) has the second highest mortality rate from COVID-19. Risk factors include cancer and lung disease;thus thoracic cancer pts are especially vulnerable. Methods: Thoracic cancer pts diagnosed with COVID-19 (PCR, radiological or clinical) at a UK academic centre between March-May 2020 were included. Data were extracted from pts records. Demographics, treatment and outcomes are described. Results: 27 pts were included, 12 (44%) diagnosed by PCR, 4 (15%) radiologically and 11 (41%) clinically. 89% had advanced thoracic malignancies. Symptoms included dyspnoea (52%), cough (67%), fever (59%), fatigue (37%), confusion (22%), diarrhoea (11%), anosmia (7%). 14 (52%) patients were hospitalised (median 6d);4 (15%) required intensive care (ICU), of which 3 died. 10 (37%) pts required oxygen, 4 (14%) required non invasive ventilation. No pts were intubated. Complications included pneumonia (26%), sepsis (11%) and ARDS (7%). 2 pts required home oxygen at discharge. 5 (19%) pts died;all were smokers. Median time from symptom onset to death was 10d (range 3-13). Cancer therapy was delayed or ceased in 11 (41%) patients. [Formula presented] Conclusions: Despite UK patient shielding and risk-minimizing therapy modifications, the immediate morbidity from COVID-19 remains high in thoracic cancer pts. Rates of hospitalisation and treatment interruption were high. Although numbers were small, no deaths occurred in never smokers or pts on single modality therapy. Continued follow up is needed to better understand the direct and indirect impacts of COVID-19 on morbidity and subsequent mortality. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: A.R. Minchom: Honoraria (self): Loxo Oncology;Honoraria (self): Janssen Pharmaceuticals;Honoraria (self): Faron Pharmaceuticals;Honoraria (self): Bayer Pharmaceuticals;Honoraria (self): Novartis Oncology;Honoraria (self): Merck Pharmaceuticals. M. Ahmed: Advisory/Consultancy, Research grant/Funding (self): BMS;Research grant/Funding (self): MSD;Speaker Bureau/Expert testimony: AstraZeneca. F. McDonald: Speaker Bureau/Expert testimony: Elekta;Advisory/Consultancy, Speaker Bureau/Expert testimony: Astra Zeneca;Advisory/Consultancy: Accuray;Research grant/Funding (institution): MSD. S. Popat: Advisory/Consultancy: BMS;Advisory/Consultancy: Roche;Advisory/Consultancy: Takeda;Advisory/Consultancy: Astra Zeneca;Advisory/Consultancy: Pfizer;Advisory/Consultancy: MSD;Advisory/Consultancy: EMD Serono;Advisory/Consultancy: Guardant Health;Advisory/Consultancy: Abbvie;Advisory/Consultancy: Boehringer Ingelheim;Advisory/Consultancy: OncLive;Advisory/Consultancy: Medscape;Advisory/Consultancy: Incyte;Advisory/Consultancy: Paradox Pharmaceuticals;Advisory/Consultancy: Eli Lilly. All other authors have declared no conflicts of interest.
ABSTRACT
BACKGROUND: Cancer diagnostics and surgery have been disrupted by the response of health care services to the coronavirus disease 2019 (COVID-19) pandemic. Progression of cancers during delay will impact on patients' long-term survival. PATIENTS AND METHODS: We generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of 3 and 6 months and periods of disruption of 1 and 2 years. Using health care resource costing, we contextualise attributable lives saved and life-years gained (LYGs) from cancer surgery to equivalent volumes of COVID-19 hospitalisations. RESULTS: Per year, 94 912 resections for major cancers result in 80 406 long-term survivors and 1 717 051 LYGs. Per-patient delay of 3/6 months would cause attributable death of 4755/10 760 of these individuals with loss of 92 214/208 275 life-years, respectively. For cancer surgery, average LYGs per patient are 18.1 under standard conditions and 17.1/15.9 with a delay of 3/6 months (an average loss of 0.97/2.19 LYGs per patient), respectively. Taking into account health care resource units (HCRUs), surgery results on average per patient in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12/1.97 RALYGs following delay of 3/6 months. For 94 912 hospital COVID-19 admissions, there are 482 022 LYGs requiring 1 052 949 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5.08 LYG and 0.46 RALYGs. CONCLUSIONS: Modest delays in surgery for cancer incur significant impact on survival. Delay of 3/6 months in surgery for incident cancers would mitigate 19%/43% of LYGs, respectively, by hospitalisation of an equivalent volume of admissions for community-acquired COVID-19. This rises to 26%/59%, respectively, when considering RALYGs. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.