1
|
Johansson AL, Skog A, Johannesen TB, Myklebust TÅ, Skovlund CW, Mørch LS, Friis S, Gamborg M, Kristiansen MF, Pettersson D, Ólafsdóttir EJ, Birgisson H, Palsson R, Eythorsson E, Irenaeus S, Lambe M, Ursin G. Were cancer patients worse off than the general population during the COVID-19 pandemic? A population-based study from Norway, Denmark and Iceland during the pre-vaccination era. THE LANCET REGIONAL HEALTH. EUROPE 2023; 31:100680. [PMID: 37547277 PMCID: PMC10398597 DOI: 10.1016/j.lanepe.2023.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023]
Abstract
Background In a population-based setting, we investigated the risks of testing positive for SARS-CoV-2 and developing severe COVID-19 outcomes among cancer patients compared with the general population. Methods In nationwide cohorts, we identified all individuals in Norway, Denmark and Iceland who tested positive for SARS-CoV-2 or had a severe COVID-19 outcome (hospitalisation, intensive care, and death) from March until December 2020, using data from national health registries. We estimated standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) comparing cancer patients with the general population. Findings During the first wave of the pandemic, cancer patients in Norway and Denmark had higher risks of testing SARS-CoV-2 positive compared to the general population. Throughout 2020, recently treated cancer patients were more likely to test SARS-CoV-2 positive. In Iceland, cancer patients experienced no increased risk of testing positive. The risk of COVID-19-related hospitalisation was higher among cancer patients diagnosed within one year of hospitalisation (Norway: SIR = 2.43, 95% CI 1.89-3.09; Denmark: 2.23, 1.96-2.54) and within five years (Norway: 1.58, 1.35-1.83; Denmark: 1.54, 1.42-1.66). Risks were higher in recently treated cancer patients and in those diagnosed with haematologic malignancies, colorectal or lung cancer. Risks of COVID-19-related intensive care and death were higher among cancer patients. Interpretation Cancer patients were at increased risk of testing positive for SARS-CoV-2 during the first pandemic wave when testing availability was limited, while relative risks of severe COVID-19 outcomes remained increased in cancer patients throughout 2020. Recent cancer treatment and haematologic malignancy were the strongest risk factors. Funding Nordic Cancer Union.
Collapse
Affiliation(s)
- Anna L.V. Johansson
- Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo N-0304, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm SE-17177, Sweden
| | - Anna Skog
- Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo N-0304, Norway
| | | | - Tor Åge Myklebust
- Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo N-0304, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Charlotte Wessel Skovlund
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Lina Steinrud Mørch
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Søren Friis
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Mads Gamborg
- Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden 49, Copenhagen DK-2100, Denmark
| | - Marnar Fríðheim Kristiansen
- Center of Health Science, Faculty of Health Sciences, Tórshavn, Faroe Islands
- National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - David Pettersson
- National Board of Health and Welfare, Stockholm SE-106 30, Sweden
| | - Elínborg J. Ólafsdóttir
- ICS Research and Registration Center, Icelandic Cancer Society, P.O. Box 5420, 105 Reykjavík, Iceland
| | - Helgi Birgisson
- ICS Research and Registration Center, Icelandic Cancer Society, P.O. Box 5420, 105 Reykjavík, Iceland
| | - Runolfur Palsson
- Landspitali-The National University Hospital of Iceland, Saemundargata 2, 102 Reykjavík, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Elias Eythorsson
- Landspitali-The National University Hospital of Iceland, Saemundargata 2, 102 Reykjavík, Iceland
| | - Sandra Irenaeus
- Regional Cancer Center Central Sweden, Akademiska Sjukhuset, Uppsala SE-751 85, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O. Box 281, Stockholm SE-17177, Sweden
- Regional Cancer Center Central Sweden, Akademiska Sjukhuset, Uppsala SE-751 85, Sweden
| | - Giske Ursin
- Cancer Registry of Norway, P.O. Box 5313 Majorstuen, Oslo N-0304, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Yang Y, Xu G. SARS-CoV-2 infection and COVID-19 vaccination in cancer patients undergoing immune checkpoint inhibitors. Cell Death Dis 2023; 14:390. [PMID: 37391394 PMCID: PMC10313683 DOI: 10.1038/s41419-023-05922-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
Cancer patients are susceptible to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Different antitumor treatments have attracted wide attention in the context of coronavirus disease 2019 (COVID-19), especially immune checkpoint inhibitors (ICIs) that have revolutionized oncology changes. It may also have protective and therapeutic roles in viral infections. In this article, we collected 26 cases of SARS-CoV-2 infection during ICIs therapy and 13 related to COVID-19 vaccination from Pubmed, EMBASE, and Wed of Science. Of these 26 cases, 19 (73.1%) presented mild cases and 7 (26.9%) were severe cases. Melanoma (47.4%) was a common cancer type in mild cases and lung cancer (71.4%) in severe cases (P = 0.016). The results showed that their clinical outcomes varied widely. Although there are similarities between the immune checkpoint pathway and COVID-19 immunogenicity, ICIs therapy overactivated T cells, which often leads to immune-related adverse events. In fact, the COVID-19 vaccine has been shown to be safe and effective in patients treated with ICIs. In this review, we report the vital clinical observations of SARS-CoV-2 infection or vaccination in cancer patients treated with ICIs and explore the potential interaction between them.
Collapse
Affiliation(s)
- Yang Yang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, PR China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, PR China.
| |
Collapse
|
3
|
Ruiz JI, Lopez-Olivo MA, Geng Y, Suarez-Almazor ME. COVID-19 Outcomes in Patients with Cancer Receiving Immune Checkpoint Inhibitors: A Systematic Review. JOURNAL OF IMMUNOTHERAPY AND PRECISION ONCOLOGY 2023; 6:103-110. [PMID: 37214207 PMCID: PMC10195019 DOI: 10.36401/jipo-22-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 05/24/2023]
Abstract
Introduction Immune checkpoint inhibitors (ICIs) can cause inflammatory and immune-related adverse events (irAEs) that might worsen the course of COVID-19. We conducted a systematic review (PROSPERO ID: CRD42022307545) to evaluate the clinical course and complications of COVID-19 in patients with cancer receiving ICI. Methods We searched Medline and Embase through January 5, 2022. We included studies evaluating patients with cancer who received ICI and developed COVID-19. Outcomes included mortality, severe COVID-19, intensive care unit (ICU) and hospital admissions, irAEs, and serious adverse events. We pooled data with random effects meta-analysis. Results Twenty-five studies met study eligibility (n = 36,532 patients: 15,497 had COVID-19 and 3220 received ICI). Most studies (71.4%) had a high risk of comparability bias. There were no significant differences in mortality (relative risk [RR] 1.29; 95% CI 0.62-2.69), ICU admission (RR 1.20; 95% CI 0.71-2.00), and hospital admission (RR 0.91; 95% CI 0.79-1.06) when comparing patients treated with ICI with patients without cancer treatment. When pooling adjusted odds ratios (ORs), no statistically significant differences were observed in mortality (OR 0.95; 95% CI 0.57-1.60), severe COVID-19 (OR 1.05; 95% CI 0.45-2.46), or hospital admission (OR 2.02; 95% CI 0.96-4.27), when comparing patients treated with ICIs versus patients with cancer without ICI therapy. No significant differences were observed when comparing clinical outcomes in patients receiving ICIs versus patients receiving any of the other anticancer therapies. Conclusion Although current evidence is limited, COVID-19 clinical outcomes of patients with cancer receiving ICI therapy appear to be similar to those not receiving oncologic treatment or other cancer therapies.
Collapse
Affiliation(s)
- Juan I. Ruiz
- Health Services Research Department, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Maria A. Lopez-Olivo
- Health Services Research Department, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Yimin Geng
- Research Medical Library, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Maria E. Suarez-Almazor
- Health Services Research Department, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| |
Collapse
|
4
|
Cortellini A, Dettorre GM, Dafni U, Aguilar-Company J, Castelo-Branco L, Lambertini M, Gennatas S, Angelis V, Sita-Lumsden A, Rogado J, Pedrazzoli P, Viñal D, Prat A, Rossi M, Berardi R, Alonso-Gordoa T, Grisanti S, Dimopoulou G, Queirolo P, Pradervand S, Bertuzzi A, Bower M, Arnold D, Salazar R, Tucci M, Harrington KJ, Mazzoni F, Mukherjee U, Tsourti Z, Michielin O, Pommeret F, Brunet J, Vincenzi B, Tonini G, Patriarca A, Biello F, Krengli M, Tabernero J, Pentheroudakis G, Gennari A, Peters S, Romano E, Pinato DJ. Immune checkpoint inhibitor therapy and outcomes from SARS-CoV-2 infection in patients with cancer: a joint analysis of OnCovid and ESMO-CoCARE registries. J Immunother Cancer 2022; 10:jitc-2022-005732. [PMID: 36450384 PMCID: PMC9716413 DOI: 10.1136/jitc-2022-005732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND As management and prevention strategies against COVID-19 evolve, it is still uncertain whether prior exposure to immune checkpoint inhibitors (ICIs) affects COVID-19 severity in patients with cancer. METHODS In a joint analysis of ICI recipients from OnCovid (NCT04393974) and European Society for Medical Oncology (ESMO) CoCARE registries, we assessed severity and mortality from SARS-CoV-2 in vaccinated and unvaccinated patients with cancer and explored whether prior immune-related adverse events (irAEs) influenced outcome from COVID-19. FINDINGS The study population consisted of 240 patients diagnosed with COVID-19 between January 2020 and February 2022 exposed to ICI within 3 months prior to COVID-19 diagnosis, with a 30-day case fatality rate (CFR30) of 23.6% (95% CI 17.8 to 30.7%). Overall, 42 (17.5%) were fully vaccinated prior to COVID-19 and experienced decreased CFR30 (4.8% vs 28.1%, p=0.0009), hospitalization rate (27.5% vs 63.2%, p<0.0001), requirement of oxygen therapy (15.8% vs 41.5%, p=0.0030), COVID-19 complication rate (11.9% vs 34.6%, p=0.0040), with a reduced need for COVID-19-specific therapy (26.3% vs 57.9%, p=0.0004) compared with unvaccinated patients. Inverse probability of treatment weighting (IPTW)-fitted multivariable analysis, following a clustered-robust correction for the data source (OnCovid vs ESMO CoCARE), confirmed that vaccinated patients experienced a decreased risk of death at 30 days (adjusted OR, aOR 0.08, 95% CI 0.01 to 0.69).Overall, 38 patients (15.8%) experienced at least one irAE of any grade at any time prior to COVID-19, at a median time of 3.2 months (range 0.13-48.7) from COVID-19 diagnosis. IrAEs occurred independently of baseline characteristics except for primary tumor (p=0.0373) and were associated with a significantly decreased CFR30 (10.8% vs 26.0%, p=0.0462) additionally confirmed by the IPTW-fitted multivariable analysis (aOR 0.47, 95% CI 0.33 to 0.67). Patients who experienced irAEs also presented a higher median absolute lymphocyte count at COVID-19 (1.4 vs 0.8 109 cells/L, p=0.0098). CONCLUSION Anti-SARS-CoV-2 vaccination reduces morbidity and mortality from COVID-19 in ICI recipients. History of irAEs might identify patients with pre-existing protection from COVID-19, warranting further investigation of adaptive immune determinants of protection from SARS-CoV-2.
Collapse
Affiliation(s)
- Alessio Cortellini
- Department of Surgery & Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK,Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Gino M Dettorre
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Urania Dafni
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain,Infectious Disease, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Luis Castelo-Branco
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland,NOVA National School of Publich Health, NOVA University, Lisbon, Portugal
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy,Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Spyridon Gennatas
- Medical Oncology Department, The Royal Marsden Hospital and NHS Foundation Trust, London, UK
| | - Vasileios Angelis
- Medical Oncology Department, The Royal Marsden Hospital and NHS Foundation Trust, London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Jacobo Rogado
- Medical Oncology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Paolo Pedrazzoli
- Medical Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy,Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - David Viñal
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain,Translational Genomics and Targeted Therapies in Solid Tumors, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maura Rossi
- Oncology Department, ASO ‘SS Antonio Biagio e Cesare Arrigo’, Alessandria, Italy
| | - Rossana Berardi
- Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | - Teresa Alonso-Gordoa
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Georgia Dimopoulou
- Laboratory of Biostatistics, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Paola Queirolo
- Melanoma Sarcoma and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sylvain Pradervand
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Dirk Arnold
- Oncology, Haematology, Palliative Care Department, Asklepios Klinik Altona e Asklepios Kliniken, Hamburg, Germany
| | - Ramon Salazar
- Department of Medical Oncology, ICO L’Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Barcelona, Spain
| | - Marco Tucci
- Section of Medical Oncology, Department of Interdisciplinary Medicine (DIM), University of Bari 'Aldo Moro', Bari, Italy,IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Kevin J Harrington
- Division of Radiotherapy and Imaging, The Royal Marsden Hospital and The Institute of Cancer Research NIHR Biomedical Research Centre, London, UK
| | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, UK
| | - Zoi Tsourti
- Frontier Science Foundation-Hellas, Athens, Greece
| | - Olivier Michielin
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Fanny Pommeret
- Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 rue Edouard Vaillant, Villejuif, France
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Bruno Vincenzi
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore della Carità, Novara, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore della Carità, Novara, Italy
| | - Marco Krengli
- Division of Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore Della Carita, Novara, Italy
| | - Josep Tabernero
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - George Pentheroudakis
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore della Carità, Novara, Italy
| | - Solange Peters
- Scientific and Medical Division, ESMO (European Society for Medical Oncology), Lugano, Switzerland,Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Emanuela Romano
- Center for Cancer Immunotherapy, Department of Oncology, PSL Research University, Institut Curie, Paris, France
| | - David J Pinato
- Department of Surgery & Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore della Carità, Novara, Italy
| |
Collapse
|
5
|
Joseph A, Lafarge A, Mabrouki A, Abdel-Nabey M, Binois Y, Younan R, Azoulay E. Severe infections in recipients of cancer immunotherapy: what intensivists need to know. Curr Opin Crit Care 2022; 28:540-550. [PMID: 35950720 DOI: 10.1097/mcc.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Given the increased number of cancer patients admitted in the ICU and the growing importance of immunotherapy in their therapeutic arsenal, intensivists will be increasingly confronted to patients treated with immunotherapies who will present with complications, infectious and immunologic. RECENT FINDINGS Apart from their specific immunologic toxicities, cancer immunotherapy recipients also have specific immune dysfunction and face increased infectious risks that may lead to intensive care unit admission. SUMMARY Chimeric antigen receptor T-cell therapy is associated with profound immunosuppression and the risks of bacterial, fungal and viral infections vary according to the time since infusion.Immune checkpoint blockers are associated with an overall favorable safety profile but associations of checkpoint blockers and corticosteroids and immunosuppressive drugs prescribed to treat immune-related adverse events are associated with increased risks of bacterial and fungal infections.The T-cell engaging bispecific therapy blinatumomab causes profound B-cell aplasia, hypogammaglobulinemia and neutropenia, but seems to be associated with fewer infectious adverse events compared with standard intensive chemotherapy.Lastly, intravesical administration of Bacillus Calmette-Guérin (BCG) can lead to disseminated BCGitis and severe sepsis requiring a specific antibiotherapy, often associated with corticosteroid treatment.
Collapse
Affiliation(s)
- Adrien Joseph
- Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Public Assistance Hospitals of Paris, Paris, France
| | | | | | | | | | | | | |
Collapse
|
6
|
Milch V, Nelson AE, Austen M, Hector D, Turnbull S, Sathiaraj R, Der Vartanian C, Wang R, Anderiesz C, Keefe D. Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic. JCO Glob Oncol 2022; 8:e2200043. [PMID: 35917484 PMCID: PMC9470141 DOI: 10.1200/go.22.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics. METHODS Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated. RESULTS Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption. CONCLUSION Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.
Collapse
Affiliation(s)
- Vivienne Milch
- Cancer Australia, Sydney, New South Wales, Australia
- The University of Notre Dame, Sydney, New South Wales, Australia
| | - Anne E. Nelson
- Evidence Review Contractor, Sydney, New South Wales, Australia
| | | | - Debra Hector
- Cancer Australia, Sydney, New South Wales, Australia
| | | | | | | | - Rhona Wang
- Cancer Australia, Sydney, New South Wales, Australia
| | - Cleola Anderiesz
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- National Breast Cancer Foundation, Sydney, New South Wales, Australia
| | - Dorothy Keefe
- Cancer Australia, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
Jiang M, Hu Y, Lin G, Chen C. Dosing Regimens of Immune Checkpoint Inhibitors: Attempts at Lower Dose, Less Frequency, Shorter Course. Front Oncol 2022; 12:906251. [PMID: 35795044 PMCID: PMC9251517 DOI: 10.3389/fonc.2022.906251] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a revolutionary breakthrough in the field of cancer by modulating patient's own immune system to exert anti-tumor effects. The clinical application of ICIs is still in its infancy, and their dosing regimens need to be continuously adjusted. Pharmacokinetic/pharmacodynamic studies showed a significant plateau in the exposure-response curve, with high receptor occupancy and plasma concentrations achieved at low dose levels. Coupled with concerns about drug toxicity and heavy economic costs, there has been an ongoing quest to reevaluate the current ICI dosing regimens while preserving maximum clinical efficacy. Many clinical data showed remarkable anticancer effects with ICIs at the doses far below the approved regimens, indicating the possibility of dose reduction. Our review attempts to summarize the clinical evidence for ICIs regimens with lower-dose, less-frequency, shorter-course, and provide clues for further ICIs regimen optimization.
Collapse
Affiliation(s)
| | | | | | - Chao Chen
- Department of Radiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
| |
Collapse
|
8
|
Furlong E, Kotecha RS, Conyers R, O'Brien TA, Hansford JR, Super L, Downie P, Eisenstat DD, Haeusler G, McMullan B, Phillips MB, Padhye B, Dalla-Pozza L, Alvaro F, Fraser CJ, Nicholls W, Clark JE, O'Connor M, Saxon BR, Tapp H, Heath J, Hunter SE, Tsui K, Winstanley M, Lyver A, Best EJ, Wadia U, Yeoh D, Blyth CC, Gottardo NG. COVID-19 vaccination in children and adolescents aged 5 years and older undergoing treatment for cancer and non-malignant haematological conditions: Australian and New Zealand Children's Haematology/Oncology Group consensus statement. Med J Aust 2022; 216:312-319. [PMID: 35201615 PMCID: PMC9115069 DOI: 10.5694/mja2.51444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The Australian Technical Advisory Group on Immunisation and New Zealand Ministry of Health recommend all children aged ≥ 5 years receive either of the two mRNA COVID-19 vaccines: Comirnaty (Pfizer), available in both Australia and New Zealand, or Spikevax (Moderna), available in Australia only. Both vaccines are efficacious and safe in the general population, including children. Children and adolescents undergoing treatment for cancer and immunosuppressive therapy for non-malignant haematological conditions are particularly vulnerable, with an increased risk of severe or fatal COVID-19. There remains a paucity of data regarding the immune response to COVID-19 vaccines in immunosuppressed paediatric populations, with data suggestive of reduced immunogenicity of the vaccine in immunocompromised adults. RECOMMENDATIONS Considering the safety profile of mRNA COVID-19 vaccines and the increased risk of severe COVID-19 in immunocompromised children and adolescents, COVID-19 vaccination is strongly recommended for this at-risk population. We provide a number of recommendations regarding COVID-19 vaccination in this population where immunosuppressive, chemotherapeutic and/or targeted biological agents are used. These include the timing of vaccination in patients undergoing active treatment, management of specific situations where vaccination is contraindicated or recommended under special precautions, and additional vaccination recommendations for severely immunocompromised patients. Finally, we stress the importance of upcoming clinical trials to identify the safest and most efficacious vaccination regimen for this population. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This consensus statement provides recommendations for COVID-19 vaccination in children and adolescents aged ≥ 5 years with cancer and immunocompromising non-malignant haematological conditions, based on evidence, national and international guidelines and expert opinion. ENDORSED BY The Australian and New Zealand Children's Haematology/Oncology Group.
Collapse
Affiliation(s)
- Eliska Furlong
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA
| | - Rishi S Kotecha
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA.,Curtin University, Perth, WA
| | - Rachel Conyers
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | - Jordan R Hansford
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Leanne Super
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Peter Downie
- Monash University, Melbourne, VIC.,Monash Children's Hospital, Melbourne, VIC.,Hudson Institute of Medical Research, Melbourne, VIC
| | - David D Eisenstat
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Gabrielle Haeusler
- Murdoch Children's Research Institute, Melbourne, VIC.,Paediatric Integrated Cancer Service, Melbourne, VIC.,National Centre for Infections in Cancer, Melbourne, VIC
| | - Brendan McMullan
- University of New South Wales, Sydney, NSW.,National Centre for Infections in Cancer, Melbourne, VIC.,Sydney Children's Hospital, Sydney, NSW
| | | | - Bhavna Padhye
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
| | - Frank Alvaro
- John Hunter Children's Hospital, Newcastle, NSW.,University of Newcastle, Newcastle, NSW
| | | | - Wayne Nicholls
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Julia E Clark
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Matthew O'Connor
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - Benjamin R Saxon
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - Heather Tapp
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - John Heath
- Children's and Adolescent/Young Adult Cancer Centre, Royal Hobart Hospital, Hobart, TAS
| | - Sarah E Hunter
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Karen Tsui
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Mark Winstanley
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Amanda Lyver
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, NZ
| | - Emma J Best
- Starship Children's Hospital, Auckland, NZ.,Immunisation Advisory Centre, University of Auckland, Auckland, NZ.,University of Auckland, Auckland, NZ
| | - Ushma Wadia
- Perth Children's Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Daniel Yeoh
- Perth Children's Hospital, Perth, WA.,National Centre for Infections in Cancer, Melbourne, VIC
| | - Christopher C Blyth
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | - Nicholas G Gottardo
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| |
Collapse
|