Repurposing Drugs for Viruses and Cancer: A Novel Drug Repositioning Strategy for COVID-19

The high infection capacity and rapid mutations in coronavirus disease 2019 (COVID-19) has been no stranger to many. The etiological agent that contributed to this global health crisis is by no means the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 is characterized by an episode of immune fluctuations, followed by hyperactivation of inflammatory responses, known as the cytokine storm. The rapid progression of the COVID-19 pandemic calls for new and promising antiviral therapeutics. Repositioning anticancer drugs against the virus is very much explored due to the common similar pathways or targeting structures, opening new windows for many possibilities. As such, the repurposing of zidovudine for Friend leukemia virus and ouabain for Ebola virus are among the successful examples. Other potential FDA-approved anticancer drugs to be repositioned for COVID-19 include imatinib, saracatinib, and homoharringtonine, which have been studied for other coronaviruses in the past. Furthermore, current anticancer drugs like carmofur, carfilzomib, zotatifin, plitidepsin, and toremifene have gained interesting outcomes with respect to SARS-CoV-2. It is well recognized that to achieve viral replication, viruses antagonise or hijack host proteins and signaling pathways to gain productive infection, with SARS-CoV-2 indeed being no exception. This review aims to discuss the drug repositioning approaches concerning previously established anticancer drugs on viruses, especially on SARS-CoV-2. We accentuate this idea with specific examples of how potential anticancer inhibitors can effectively be used against SARS-CoV-2 as well as the limitations and future perspectives of drug repositioning. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

The real-world impact of the COVID-19 pandemic on patients with cancer: a multidisciplinary cross-sectional survey.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented disruptions to cancer care worldwide. We conducted a multidisciplinary survey of the real-world impact of the pandemic, as perceived by patients with cancer. METHODS: A total of 424 patients with cancer were surveyed using a 64-item questionnaire constructed by a multidisciplinary panel. The questionnaire examined patient perspectives regarding COVID-19-related effects (eg, social distancing measures) on cancer care delivery, resources, and healthcare-seeking behaviour, along with the physical and psychosocial aspects of patient well-being and pandemic-related psychological repercussions. RESULTS: Overall, 82.8% of respondents believed that patients with cancer are more susceptible to COVID-19; 65.6% expected that COVID-19 would delay anti-cancer drug development. Although only 30.9% of respondents felt that hospital attendance was safe, 73.1% expressed unaltered willingness to attend scheduled appointments; 70.3% of respondents preferred to receive chemotherapy as planned, and 46.5% were willing to accept changes in efficacy or side-effect profile to allow an outpatient regimen. A survey of oncologists revealed significant underestimation of patient motivation to avoid treatment interruptions. Most surveyed patients felt that there was an insufficient amount of information available concerning the impact of COVID-19 on cancer care, and most patients reported social distancing-related declines in physical, psychological, and dietary wellness. Sex, age, education level, socio-economic status, and psychological risk were significantly associated with patient perceptions and preferences. CONCLUSION: This multidisciplinary survey concerning the effects of the COVID-19 pandemic revealed key patient care priorities and unmet needs. These findings should be considered when delivering cancer care during and after the pandemic.

Toward sustainable express deliveries for online shopping: Reusing packaging materials through reverse logistics

The COVID-19 pandemic has led to an increase in online purchases, which has inevitably raised the demand for express delivery packaging materials (EDPMs). This study proposes a reverse logistics reuse framework that extends the EDPM life cycle by drawing on insights and conclusions from a review of the literature on supply chain management and materials science to achieve a sustainable e-commerce system. A key benefit of reverse logistics is its effectiveness in exploiting opportunities for resource reuse, which is preferred to recycling. By extending service life through resource optimization, recycling, and recovery processes, the novel reuse framework based on reverse logistics can be implemented with minimal changes to existing forward logistics systems, potentially leading to more sustainable online shopping. This study proposes a novel combination of reusable packaging materials and reverse logistics as a viable and more environmentally friendly practice, in line with circular economy goals. © 2022 The Authors. Thunderbird International Business Review published by Wiley Periodicals LLC.

Research process development mitigates effect of COVID-19 on stroke trial enrollment

Introduction: With hundreds of thousands of clinical trial patients enrolled yearly, the COVID-19 pandemic caused a significant, unexpected disruption in clinical trials across the world. US data showed a 70% enrollment reduction in April and a 38% reduction in July 2020, compared to prepandemic rates. We implemented processes during the initial phase of the pandemic to minimize participant and staff viral exposure, develop remote procedures, and ease communication barriers, while still maintaining enrollment goals. Methods: Our stroke research team developed multiple processes to help mitigate pandemic effects on our enrollment. We developed watchlists for eligible and interested patients who could not be enrolled due to national and local restrictions. As research staff was unable to approach patients in person, phone and email scripts were developed to ensure information was disseminated in a consistent fashion. Remote and alternate consent methods were implemented. We tracked the evolving national and local guideline changes, and began re-opening trials on May 23, 2020. We implemented a rotating pool of coordinators, including a site-specific sanitation plan, once it was safe to be on campus in-person. In person meetings were moved to a virtual platform. Enrollment data across for 10 active subacute stroke studies, each active over the 3 years of, 2018-2020, was analyzed for the months from March to June, with 2020 individually compared to 2018 and 2019 via the Student T-Test. Results: Total enrollment during these 4 months were 15 participants in 2018, 11 in 2019, and 15 in 2020, with no statistical difference between the years. No study patients nor staff contracted symptoms of COVID-19. Conclusion: Enrollment shows no significant changes despite COVID-19. New processes allowedthe timely reopening of clinical trials, an overall maintenance of enrollment rates, including a non-significant increase in 2020 compared to previous years. Our telehealth and virtual communicationfocused processes prioritize the safety of patients and staff while ensuring quality control andappropriate enrollment numbers.

Cancer patients' perspectives on the real-world impact of COVID-19 pandemic: A multidisciplinary survey

Background: The outbreak of the COVID-19 pandemic has led to unprecedented disruptions to global cancer care delivery. We conducted this multidisciplinary survey to gain insights into the real-life impact of the pandemic as perceived by cancer patients. Methods: Cancer patients at various stages of their cancer journeys were surveyed with a questionnaire constructed by a multidisciplinary panel of oncologists, clinical psychologists, occupational therapists, physiotherapists and dieticians. The 64-question survey covered patient's concerns on cancer care resources, treatment provision and quality, changes in health-seeking behaviour;the impact of social isolation on physical wellbeing and psychological repercussions. Results: 600 cancer patients in Hong Kong were surveyed in May 2020. Preliminary results showed that 70% of respondents related a COVID-19 diagnosis to compromised cancer treatment and outcome. Although only 45% considered hospital attendance as safe, 80% indicated their willingness to attend oncology appointments remained unaffected. 91% of patients stated their decision to receive chemotherapy was not changed;however, 40% would be willing to trade off the efficacy/side-effect profile for an outpatient regimen. Patients also reported compromised physical wellbeing due to social isolation, in particular, deterioration in exercise tolerance & limb power (44%), reduced appetite (29%), worse sleep quality (35%). Interestingly, 59% of pts reported better care support as a result of family spending more time together. Anxiety and depression were reported in 70% and 54% of patients, respectively. In addition, 20 oncologists provided their predictions on changes in pt's health-seeking behaviours under the pandemic. Results showed that they significantly underestimated patients' willingness and preference to keep their scheduled oncology appointments and treatments despite the risk involved. Conclusions: This original survey revealed the breadth and profoundness of the impact of the COVID-19 pandemic as perceived by cancer patients, headlining patients’ care priorities and showing their unmet needs. It should be taken into consideration as we modify the way cancer care is provided during this unsettling period and beyond. Legal entity responsible for the study: The authors. Funding: The Kowloon Central Cluster Research Committee KCC Research Grant 2020/21, Hong Kong (KCC/RC/G/2021-B01). Disclosure: All authors have declared no conflicts of interest.

Short- and potential long-term adverse health outcomes of COVID-19: a rapid review.

The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of patients infected worldwide and indirectly affecting even more individuals through disruption of daily living. Long-term adverse outcomes have been reported with similar diseases from other coronaviruses, namely Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Emerging evidence suggests that COVID-19 adversely affects different systems in the human body. This review summarizes the current evidence on the short-term adverse health outcomes and assesses the risk of potential long-term adverse outcomes of COVID-19. Major adverse outcomes were found to affect different body systems: immune system (including but not limited to Guillain-Barré syndrome and paediatric inflammatory multisystem syndrome), respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy and coagulopathy), neurological system (sensory dysfunction and stroke), as well as cutaneous and gastrointestinal manifestations, impaired hepatic and renal function. Mental health in patients with COVID-19 was also found to be adversely affected. The burden of caring for COVID-19 survivors is likely to be huge. Therefore, it is important for policy makers to develop comprehensive strategies in providing resources and capacity in the healthcare system. Future epidemiological studies are needed to further investigate the long-term impact on COVID-19 survivors.

Radiological Findings in COVID-19 and Adaptive Approaches for Radiology Departments: Literature Review and Experience Sharing

Radiological investigations play an important role in the treatment course of patients with coronavirus disease 2019 (COVID-19) and radiologists should be familiar with the imaging characteristics. Being an integral component of the healthcare system, radiology departments have made adaptations to enhance infection control and strengthen the service. In this article, we review the radiological features of COVID-19 on chest radiography and computed tomography, and share experiences on the adaptive approach of radiology departments amidst the COVID-19 pandemic.