COVID-19 risk for patients undergoing anticancer treatment at the outpatient clinic of the National Cancer Institute of Milan: The COVINT study

ABSTRACT

Background: In the midst of COVID-19 pandemic, cancer patients (pts) are regarded as a highly vulnerable population. Pts requiring hospital admission for treatment (Tx) administration are potentially exposed to a higher risk of infection and worse outcome given the multiple in-hospital exposures and the Tx immunosuppressive effects. Methods: COVINT is an observational study assessing COVID-19 incidence among pts receiving anticancer Tx in the outpatient clinic of the Istituto Nazionale dei Tumori di Milano. All consecutive pts with non-hematologic malignancies treated with intravenous or subcutaneous/intramuscular Tx in the outpatient clinic were enrolled. Pts were admitted to the clinic wearing surgical masks and only if asymptomatic and afebrile. The primary endpoint is the rate of occurrence of COVID-19. Secondary endpoints include the rate of COVID-19 related deaths and Tx interruptions. The association between clinical and biological characteristics and COVID-19 occurrence is also evaluated using nonparametric tests. COVID-19 diagnosis is defined as a) certain if confirmed by RT-PCR assay of nasopharyngeal swabs (NFS);b) suspected in case of new symptoms and/or CT scan evidence of interstitial pneumonia with negative/not performed NFS;c) negative in case of neither symptoms nor radiological evidence. Results: In the first two months (16th February-10th April 2020) of observation, 1083 pts were included. Of these, 11 (1%) were confirmed and 73 (6.7%) suspected for COVID-19. No significant differences in terms of cancer and Tx type emerged between the three subgroups. Prophylactic use of myeloid growth factors was adopted in 5.3%, 2.7% and 0% of COVID-19-free, -suspected and -confirmed pts (p=0.003). Overall, 96 (8.9%) pts delayed Tx as a precaution for the pandemic. Among the 11 confirmed cases, 6 (55%) died of COVID-19 complications, and anticancer Tx was restarted in only one. Conclusions: During the pandemic peak, accurate protective measures successfully resulted in low rates of COVID-19 diagnosis, though with high lethality. Within the COVINT study, prospective pts surveillance will continue with NFS swabs and IgG/IgM serology performed before each Tx cycle until pandemic resolution. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure F.G.M. De Braud Advisory/Consultancy Tiziana Life Sciences;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses BMS;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses Celgene;Advisory/Consultancy, Research grant/Funding (institution) Novartis;Advisory/Consultancy Servier;Advisory/Consultancy Pharm Research Associated;Advisory/Consultancy Daiichi Sankyo;Advisory/Consultancy, Speaker Bureau/Expert testimony Ignyta;Advisory/Consultancy, Travel/Accommodation/Expenses Amgen;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution) Pfizer;Advisory/Consultancy Octimet Oncology;Advisory/Consultancy, Research grant/Funding (institution) Incyte;Advisory/Consultancy Pierre Fabre;Advisory/Consultancy Eli Lilly;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution), Travel/Accommodation/Expenses Roche;Advisory/Consultancy Astra Zeneca;Advisory/Consultancy Gentili;Advisory/Consultancy, Speaker Bureau/Expert testimony Dephaforum;Advisory/Consultancy, Speaker Bureau/Expert testimony, Research grant/Funding (institution) MSD;Advisory/Consultancy, Speaker Bureau/Expert testimony Bayer;Advisory/Consultancy Fondazione Menarini;Research grant/Funding (self) NMS;Research grant/Funding (institution) Merck KGAA;Research grant/Funding (institution) Kymab;Research grant/Funding (institution) Tesaro;Speaker Bureau/Expert testimony Biotechespert Ltd;Speaker Bureau/Expert testimony Prime Oncology. All other authors have declared no conflicts of interest.