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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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Cariti C, Merli M, Avallone G, Rubatto M, Marra E, Fava P, Caliendo V, Picciotto F, Gualdi G, Stanganelli I, Fierro MT, Ribero S, Quaglino P. Melanoma Management during the COVID-19 Pandemic Emergency: A Literature Review and Single-Center Experience. Cancers (Basel) 2021; 13:cancers13236071. [PMID: 34885180 PMCID: PMC8656565 DOI: 10.3390/cancers13236071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/22/2021] [Accepted: 11/28/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary COVID-19 is a highly contagious infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In March 2020, the World Health Organization (WHO) declared that COVID-19 had become a pandemic; since then, several elective clinical and surgical activities have been postponed to reduce the risk of nosocomial infection. This has influenced the diagnosis and management of many diseases, including melanoma. The aim of our literature review was to evaluate whether the management of melanoma has been changed by the outbreak of COVID-19, and if so, what the consequences of these changes are. The main topics in this literature review are the screening of suspicious lesions, diagnosis of primary melanoma, and the management of early-stage and advanced melanomas in the COVID-19 era. We also reported the experience of our dermatological clinic in Turin, one of the most affected areas in Italy. Abstract Background: The current COVID-19 pandemic has influenced the modus operandi of all fields of medicine, significantly impacting patients with oncological diseases and multiple comorbidities. Thus, in recent months, the establishment of melanoma management during the emergency has become a major area of interest. In addition to original articles, case reports and specific guidelines for the period have been developed. Purpose: This article aims to evaluate whether melanoma management has been changed by the outbreak of COVID-19, and if so, what the consequences are. We summarized the main issues concerning the screening of suspicious lesions, the diagnosis of primary melanoma, and the management of early-stage and advanced melanomas during the pandemic. Additionally, we report on the experience of our dermatological clinic in northern Italy. Methods: We performed a literature review evaluating articles on melanomas and COVID-19 published in the last two years on PubMed, as well as considering publications by major healthcare organizations. Concerning oncological practice in our center, we collected data on surgical and therapeutic procedures in patients with a melanoma performed during the first months of the pandemic. Conclusions: During the emergency period, the evaluation of suspicious skin lesions was ensured as much as possible. However, the reduced level of access to medical care led to a documented delay in the diagnosis of new melanomas. When detected, the management of early-stage and advanced melanomas was fully guaranteed, whereas the follow-up visits of disease-free patients have been postponed or replaced with a teleconsultation when possible.
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Affiliation(s)
- Caterina Cariti
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Martina Merli
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
- Correspondence: ; Tel.: +39-011-633-5843
| | - Gianluca Avallone
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Marco Rubatto
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Elena Marra
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Paolo Fava
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Virginia Caliendo
- Dermatologic Surgery Department, Surgery Department, University Hospital, 10126 Turin, Italy; (V.C.); (F.P.)
| | - Franco Picciotto
- Dermatologic Surgery Department, Surgery Department, University Hospital, 10126 Turin, Italy; (V.C.); (F.P.)
| | - Giulio Gualdi
- Department of Medicine and Ageing Science, Dermatologic Clinic, “G. D’Annunzio” University, 66100 Chieti, Italy;
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS-IRST Scientific Institute of Romagna for the Study and Treatment of Cancer, Meldola and University of Parma, 43121 Parma, Italy;
| | - Maria Teresa Fierro
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Simone Ribero
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatology Clinic, University of Turin, 10126 Turin, Italy; (C.C.); (G.A.); (M.R.); (E.M.); (P.F.); (M.T.F.); (S.R.); (P.Q.)
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Rapoport BL, Shannon VR, Cooksley T, Johnson DB, Anderson L, Blidner AG, Tintinger GR, Anderson R. Pulmonary Toxicities Associated With the Use of Immune Checkpoint Inhibitors: An Update From the Immuno-Oncology Subgroup of the Neutropenia, Infection & Myelosuppression Study Group of the Multinational Association for Supportive Care in Cancer. Front Pharmacol 2021; 12:743582. [PMID: 34675810 PMCID: PMC8523897 DOI: 10.3389/fphar.2021.743582] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
The development of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, with agents such as nivolumab, pembrolizumab, and cemiplimab targeting programmed cell death protein-1 (PD-1) and durvalumab, avelumab, and atezolizumab targeting PD-ligand 1 (PD-L1). Ipilimumab targets cytotoxic T lymphocyte-associated antigen-4 (CTLA-4). These inhibitors have shown remarkable efficacy in melanoma, lung cancer, urothelial cancer, and a variety of solid tumors, either as single agents or in combination with other anticancer modalities. Additional indications are continuing to evolve. Checkpoint inhibitors are associated with less toxicity when compared to chemotherapy. These agents enhance the antitumor immune response and produce side- effects known as immune-related adverse events (irAEs). Although the incidence of immune checkpoint inhibitor pneumonitis (ICI-Pneumonitis) is relatively low, this complication is likely to cause the delay or cessation of immunotherapy and, in severe cases, may be associated with treatment-related mortality. The primary mechanism of ICI-Pneumonitis remains unclear, but it is believed to be associated with the immune dysregulation caused by ICIs. The development of irAEs may be related to increased T cell activity against cross-antigens expressed in tumor and normal tissues. Treatment with ICIs is associated with an increased number of activated alveolar T cells and reduced activity of the anti-inflammatory Treg phenotype, leading to dysregulation of T cell activity. This review discusses the pathogenesis of alveolar pneumonitis and the incidence, diagnosis, and clinical management of pulmonary toxicity, as well as the pulmonary complications of ICIs, either as monotherapy or in combination with other anticancer modalities, such as thoracic radiotherapy.
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Affiliation(s)
- Bernardo L Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,The Medical Oncology Centre of Rosebank, Johannesburg, South Africa.,The Multinational Association for Supportive Care in Cancer (MASCC), Immuno-Oncology Subgroup of the Neutropenia, Infection and Myelosuppression Study Group, Manchester, United Kingdom
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tim Cooksley
- The Multinational Association for Supportive Care in Cancer (MASCC), Immuno-Oncology Subgroup of the Neutropenia, Infection and Myelosuppression Study Group, Manchester, United Kingdom.,Manchester University Foundation Trust, Manchester, United Kingdom.,The Christie, University of Manchester, Manchester, United Kingdom
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Centre and Vanderbilt Ingram Cancer Center, Nashville, TN, United States
| | - Lindsay Anderson
- Department of Radiation Oncology, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ada G Blidner
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine, CONICET, Buenos Aires, Argentina
| | - Gregory R Tintinger
- Department of Internal Medicine, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,The Multinational Association for Supportive Care in Cancer (MASCC), Immuno-Oncology Subgroup of the Neutropenia, Infection and Myelosuppression Study Group, Manchester, United Kingdom
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Teuscher M, Diehl K, Schaarschmidt ML, Weilandt J, Sasama B, Ohletz J, Könnecke A, Harth W, Hillen U, Peitsch WK. Effects of the COVID-19 pandemic on care of melanoma patients in Berlin, Germany: the Mela-COVID survey. Eur J Dermatol 2021. [PMID: 34463283 DOI: 10.1684/ejd.2021.4098] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The COVID-19 pandemic imposes major challenges for care of cancer patients. Objectives Our aim was to assess the effects of the pandemic on treatment and appointments of patients with malignant melanoma based on a large skin cancer centre in Berlin, Germany, and identify reasons for, and impact factors associated with these changes. Materials & Methods Patients with melanoma treated from January 1st 2019 received a postal survey with questions on impairment due to the pandemic, fear of COVID-19, fear of melanoma, changes in therapy and/or appointments, including reasons for the changes. Impact factors on postponed/missed appointments were examined using descriptive analyses and multivariate logistic regression. Results The response rate was 41.3% (n = 324; 57.4% males; mean age: 67.9 years). Among 104 participants currently receiving therapy, four (3.8%) reported treatment changes due to the pandemic. Postponements or cancellations of appointments occurred in 48 participants (14.8%), most frequently, at their own request (81.3%) due to fear of SARS-CoV-2 infection (68.8%). Current treatment was associated with a reduced chance of postponing/missing appointments (OR = 0.208, p = 0.003), whereas a high or very high level of concern for COVID-19 (OR = 6.806, p = 0.034; OR = 10.097, p = 0.038), SARS-CoV-2 infection among close acquaintances (OR = 4.251, p = 0.026), anxiety disorder (OR = 5.465, p = 0.016) and AJCC stage IV (OR = 3.108, p = 0.048) were associated with a higher likelihood of postponing/missing appointments. Conclusion Among our participants, treatment changes were rare and the proportion of missed/delayed appointments was rather small. The main reasons for delays/cancellations of appointments were anxiety and concern for COVID-19. Supplementary data Supplementary data associated with this article can be found, in the online version, at doi:10.1684/ejd.2021.4098. Table S1. Disease and treatment characteristics and their association with postponed/missed appointments. Table S2. Treatment changes or postponement due to the pandemic. Table S3. Comorbidities and their association with postponed/missed appointments. Fig. S1. Number of new SARS-CoV-2 infections per day in Germany and Berlin between February 1st 2020 and July 1st 2020.
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Awadasseid A, Yin Q, Wu Y, Zhang W. Potential protective role of the anti-PD-1 blockade against SARS-CoV-2 infection. Biomed Pharmacother 2021; 142:111957. [PMID: 34339917 PMCID: PMC8315943 DOI: 10.1016/j.biopha.2021.111957] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 12/20/2022] Open
Abstract
The outbreak of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, in December 2019, and its global dissemination became the coronavirus disease 2019 (COVID-19) pandemic declared by the World Health Organization (WHO) on 11 March 2020. In patients undergoing immunotherapy, the effect and path of viral infection remain uncertain. In addition, viral-infected mice and humans show T-cell exhaustion, which is identified after infection with SARS-CoV-2. Notably, they regain their T-cell competence and effectively prevent viral infection when treated with anti-PD-1 antibodies. Four clinical trials are officially open to evaluate anti-PD-1 antibody administration's effectiveness for cancer and non-cancer individuals influenced by COVID-19 based on these findings. The findings may demonstrate the hypothesis that a winning strategy to combat SARS-CoV-2 infection could be the restoration of exhausted T-cells. In this review, we outline the potential protective function of the anti-PD-1 blockade against SARS-CoV-2 infection with the aim to develop SARS-CoV-2 therapy.
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Affiliation(s)
- Annoor Awadasseid
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, China; Department of Biochemistry & Food Sciences, University of Kordofan, El-Obeid 51111, Sudan
| | - Qiang Yin
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China
| | - Yanling Wu
- Lab of Molecular Immunology, Virus Inspection Department, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China.
| | - Wen Zhang
- Lab of Chemical Biology and Molecular Drug Design, College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou 310014, China; Institute of Drug Development & Chemical Biology, Zhejiang University of Technology, Hangzhou 310014, China.
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Lazarus G, Budiman RA, Rinaldi I. Does immune checkpoint inhibitor increase the risks of poor outcomes in COVID-19-infected cancer patients? A systematic review and meta-analysis. Cancer Immunol Immunother 2021; 71:373-386. [PMID: 34173850 PMCID: PMC8233621 DOI: 10.1007/s00262-021-02990-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
Background The association between immune checkpoint inhibitor (ICI) and outcomes of cancer patients with coronavirus disease 2019 (COVID-19) infection has yet to be systematically evaluated. This meta-analysis aims to investigate the effects of ICI treatment on COVID-19 prognosis, including mortality, severity, and any other prognosis-related outcomes. Methods Eligible studies published up to 27 February 2021 were included and assessed for risk of bias using the Quality in Prognosis Studies tool. A random-effects meta-analysis was conducted to estimate the pooled effect size along with its 95% confidence intervals. The quality of body evidence was evaluated using the modified Grading of Recommendations Assessment, Development, and Evaluation framework. Results Eleven studies involving a total of 2826 COVID-19-infected cancer patients were included in the systematic review. We discovered a moderate-to-high quality of evidence that ICI was not associated with a higher mortality risk, while the other outcomes yielded a very low-to-low-evidence quality. Although our findings indicated that ICI did not result in a higher risk of severity and hospitalization, further evidence is required to confirm our findings. In addition, we discovered that prior exposure to chemoimmunotherapy may be linked with a higher risk of COVID-19 severity (OR 8.19 [95% CI: 2.67–25.08]; I2 = 0%), albeit with small sample size. Conclusion Our findings indicated that ICI treatment should not be adjourned nor terminated during the current pandemic. Rather, COVID-19 vigilance should be increased in such patients. Further studies with larger cohorts and higher quality of evidence are required to substantiate our findings. Trial registration number This project has been prospectively registered at PROSPERO (registration ID: CRD42020202142) on 4 August 2020. Supplementary Information The online version contains supplementary material available at 10.1007/s00262-021-02990-9.
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Affiliation(s)
- Gilbert Lazarus
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, RW 5, Kenari, Kec. Senen, Kota Jakarta Pusat, Jakarta, 10430, Indonesia.
| | - Refael Alfa Budiman
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya No. 6, RW 5, Kenari, Kec. Senen, Kota Jakarta Pusat, Jakarta, 10430, Indonesia
| | - Ikhwan Rinaldi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon 2021; 7:e06454. [PMID: 33748501 PMCID: PMC7966996 DOI: 10.1016/j.heliyon.2021.e06454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.
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Affiliation(s)
- Pooya Afaghi
- Department of Chemistry, University of Guelph, ON, Canada
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Trojaniello C, Vitale MG, Ascierto PA. Checkpoint inhibitor therapy for skin cancer may be safe in patients with asymptomatic COVID-19. Ann Oncol 2021; 32:674-676. [PMID: 33600920 PMCID: PMC7884251 DOI: 10.1016/j.annonc.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- C Trojaniello
- Department Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - M G Vitale
- Department Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - P A Ascierto
- Department Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy.
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Quaglino P, Fava P, Brizio M, Marra E, Rubatto M, Merli M, Tonella L, Ribero S, Fierro MT. Anti-BRAF/anti-MEK targeted therapies for metastatic melanoma patients during the COVID-19 outbreak: experience from an Italian skin cancer unit. Future Oncol 2021; 17:759-761. [PMID: 33533662 PMCID: PMC7874884 DOI: 10.2217/fon-2020-0997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Pietro Quaglino
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Paolo Fava
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Matteo Brizio
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Elena Marra
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Marco Rubatto
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Martina Merli
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Luca Tonella
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
| | - Simone Ribero
- Dermatology Clinic, University of Turin, Turin, 10124, Italy
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Dai Z, Zeng D, Cui D, Wang D, Feng Y, Shi Y, Zhao L, Xu J, Guo W, Yang Y, Zhao X, Li D, Zheng Y, Wang A, Wu M, Song S, Lu H. Prediction of COVID-19 Patients at High Risk of Progression to Severe Disease. Front Public Health 2020; 8:574915. [PMID: 33330318 PMCID: PMC7732480 DOI: 10.3389/fpubh.2020.574915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
In order to develop a novel scoring model for the prediction of coronavirus disease-19 (COVID-19) patients at high risk of severe disease, we retrospectively studied 419 patients from five hospitals in Shanghai, Hubei, and Jiangsu Provinces from January 22 to March 30, 2020. Multivariate Cox regression and orthogonal projections to latent structures discriminant analysis (OPLS-DA) were both used to identify high-risk factors for disease severity in COVID-19 patients. The prediction model was developed based on four high-risk factors. Multivariate analysis showed that comorbidity [hazard ratio (HR) 3.17, 95% confidence interval (CI) 1.96–5.11], albumin (ALB) level (HR 3.67, 95% CI 1.91–7.02), C-reactive protein (CRP) level (HR 3.16, 95% CI 1.68–5.96), and age ≥60 years (HR 2.31, 95% CI 1.43–3.73) were independent risk factors for disease severity in COVID-19 patients. OPLS-DA identified that the top five influencing parameters for COVID-19 severity were CRP, ALB, age ≥60 years, comorbidity, and lactate dehydrogenase (LDH) level. When incorporating the above four factors, the nomogram had a good concordance index of 0.86 (95% CI 0.83–0.89) and had an optimal agreement between the predictive nomogram and the actual observation with a slope of 0.95 (R2 = 0.89) in the 7-day prediction and 0.96 (R2 = 0.92) in the 14-day prediction after 1,000 bootstrap sampling. The area under the receiver operating characteristic curve of the COVID-19-American Association for Clinical Chemistry (AACC) model was 0.85 (95% CI 0.81–0.90). According to the probability of severity, the model divided the patients into three groups: low risk, intermediate risk, and high risk. The COVID-19-AACC model is an effective method for clinicians to screen patients at high risk of severe disease.
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Affiliation(s)
- Zhenyu Dai
- Department of Invasive Technology, Yancheng Clinical Medical College of Nanjing Medical University, Yancheng, China
| | - Dong Zeng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dawei Cui
- Department of Blood Transfusion, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dawei Wang
- Department of Infectious Disease, The Second People's Hospital of Yancheng City, Yancheng, China
| | - Yanling Feng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuhan Shi
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Liangping Zhao
- Department of Gynecology and Obstetrics, Tongji Medical College, Wuhan Central Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Xu
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wenjuan Guo
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuexiang Yang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xinguo Zhao
- Department of Respiration, The Fifth People's Hospital of Wuxi, Wuxi, China
| | - Duoduo Li
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ye Zheng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ao Wang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Minmin Wu
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Shu Song
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Disease and Immunology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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12
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Gambichler T, Reuther J, Scheel CH, Susok L, Kern P, Becker JC. Cancer and Immune Checkpoint Inhibitor Treatment in the Era of SARS-CoV-2 Infection. Cancers (Basel) 2020; 12:E3383. [PMID: 33207589 DOI: 10.3390/cancers12113383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The introduction of immune checkpoint inhibitors (ICI) in 2011 revolutionized the management of many solid cancers and hematological malignancies. However, there are concerns regarding the use of ICI in the era of COVID-19. We present currently available information on the pros and cons of using ICI in cancer patients with respect to the risk of acquiring an infection by SARS-CoV2 and mortality from COVID-19. By means of the present paper, clinicians and researchers may update their knowledge on a highly topical clinical question—is the use of ICI in cancer patients with SARS-CoV2 infection harmful with respect to COVID-19 outcome? Abstract Whether cancer patients receiving immune checkpoint inhibitors (ICI) are at an increased risk of severe infection and mortality during the corona pandemic is a hotly debated topic that will continue to evolve. Here, we summarize and discuss current studies regarding COVID-19 and anti-cancer treatment with an emphasis on ICI. Importantly, several lines of evidence suggest that patients currently treated with ICI do not display an increased vulnerability to infection with SARS-CoV-2. Data regarding morbidity and mortality associated with COVID-19 in cancer patients receiving ICI are less clear and often conflicting. Although mostly based on experimental data, it is possible that ICI can promote the exacerbated immune response associated with adverse outcome in COVID-19 patients. On the other hand, mounting evidence suggests that ICI might even be useful in the treatment of viral infections by preventing or ameliorating T cell exhaustion. In this context, the right timing of treatment might be essential. Nevertheless, some cancer patients treated with ICI experience autoimmune-related side effects that require the use of immunosuppressive therapies, which in turn may promote a severe course of infection with SARS-CoV-2. Although there is clear evidence that withholding ICI will have more serious consequences, further studies are urgently needed in to better evaluate the effects of ICI in patients with COVID-19 and the use of ICI during the corona pandemic in general.
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13
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Bersanelli M, Giannarelli D, De Giorgi U, Pignata S, Di Maio M, Verzoni E, Clemente A, Guadalupi V, Signorelli D, Tiseo M, Giusti R, Filetti M, Di Napoli M, Calvetti L, Cappetta A, Ermacora P, Zara D, Barbieri F, Baldessari C, Scotti V, Mazzoni F, Veccia A, Guglielmini PF, Maruzzo M, Rossi E, Grossi F, Casadei C, Cortellini A, Verderame F, Montesarchio V, Rizzo M, Mencoboni M, Zustovich F, Fratino L, Cinieri S, Negrini G, Banzi M, Sorarù M, Zucali PA, Lacidogna G, Russo A, Battelli N, Fornarini G, Mucciarini C, Bracarda S, Bonetti A, Pezzuolo D, Longo L, Sartori D, Iannopollo M, Cavanna L, Meriggi F, Tassinari D, Corbo C, Gernone A, Prati V, Carnio S, Giordano P, Dicorato AM, Verusio C, Atzori F, Carrozza F, Gori S, Castro A, Pilotto S, Vaccaro V, Garzoli E, Di Costanzo F, Maiello E, Labianca R, Pinto C, Tognetto M, Buti S. Symptomatic COVID-19 in advanced-cancer patients treated with immune-checkpoint inhibitors: prospective analysis from a multicentre observational trial by FICOG. Ther Adv Med Oncol 2020; 12:1758835920968463. [PMID: 33224275 PMCID: PMC7649863 DOI: 10.1177/1758835920968463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/02/2020] [Indexed: 12/30/2022] Open
Abstract
Background This prospective, multicentre, observational INVIDIa-2 study is investigating the clinical efficacy of influenza vaccination in advanced-cancer patients receiving immune-checkpoint inhibitors (ICIs), enrolled in 82 Italian centres, from October 2019 to January 2020. The primary endpoint was the incidence of influenza-like illness (ILI) until 30 April 2020. All the ILI episodes, laboratory tests, complications, hospitalizations and pneumonitis were recorded. Therefore, the study prospectively recorded all the COVID-19 ILI events. Patients and methods Patients were included in this non-prespecified COVID-19 analysis, if alive on 31 January 2020, when the Italian government declared the national emergency. The prevalence of confirmed COVID-19 cases was detected as ILI episode with laboratory confirmation of SARS-CoV-2. Cases with clinical-radiological diagnosis of COVID-19 (COVID-like ILIs), were also reported. Results Out of 1257 enrolled patients, 955 matched the inclusion criteria for this unplanned analysis. From 31 January to 30 April 2020, 66 patients had ILI: 9 of 955 cases were confirmed COVID-19 ILIs, with prevalence of 0.9% [95% confidence interval (CI): 0.3-2.4], a hospitalization rate of 100% and a mortality rate of 77.8%. Including 5 COVID-like ILIs, the overall COVID-19 prevalence was 1.5% (95% CI: 0.5-3.1), with 100% hospitalization and 64% mortality. The presence of elderly, males and comorbidities was significantly higher among patients vaccinated against influenza versus unvaccinated (p = 0.009, p < 0.0001, p < 0.0001). Overall COVID-19 prevalence was 1.2% for vaccinated (six of 482 cases, all confirmed) and 1.7% for unvaccinated (8 of 473, 3 confirmed COVID-19 and 5 COVID-like), p = 0.52. The difference remained non-significant, considering confirmed COVID-19 only (p = 0.33). Conclusion COVID-19 has a meaningful clinical impact on the cancer-patient population receiving ICIs, with high prevalence, hospitalization and an alarming mortality rate among symptomatic cases. Influenza vaccination does not protect from SARS-CoV-2 infection.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma, and Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, Parma 43126, Italy
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Lazio, Italy
| | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura de Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin and Medical Oncology, AO Ordine Mauriziano, Turin, Italy
| | - Elena Verzoni
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Alberto Clemente
- Biostatistics and Clinical Research Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Guadalupi
- SS Oncologia Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Diego Signorelli
- Thoracic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Marcello Tiseo
- Medicine and Surgery Department, University of Parma, Parma, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, Roma, Italy
| | - Marco Filetti
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Sant'Andrea - Sapienza Facoltà di Medicina e Psicologia, Roma, Italy
| | - Marilena Di Napoli
- Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, SSD Oncologia Clinica Sperimentale Uro-Andrologica, Istituto Nazionale Tumori 'Fondazione G. Pascale', IRCCS, Napoli, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Alessandro Cappetta
- Department of Oncology, San Bortolo General Hospital, Unità Locale Socio-Sanitaria (ULSS) 8 Berica-East District, Vicenza, Italy
| | - Paola Ermacora
- Dipartimento di Oncologia, Presidio Ospedaliero Universitario Santa Maria della Misericordia, Azienda sanitaria universitaria integrata Friuli Centrale, Udine, Italy
| | - Diego Zara
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Fausto Barbieri
- Medical Oncology Unit, University Hospital of Modena, Modena, Italy
| | | | - Vieri Scotti
- Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | | | | | - Marco Maruzzo
- Oncologia Medica 1, Istituto Oncologico Veneto IOV-IRCCS, Padova
| | - Ernesto Rossi
- Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Grossi
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessio Cortellini
- Department of Biotechnological and Applied Clinical Sciences, St. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Vincenzo Montesarchio
- UOC Oncologia, Ospedale Monaldi, Azienda Ospedaliera Specialistica dei Colli, Napoli, Italy
| | - Mimma Rizzo
- Oncologia Traslazionale, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Fable Zustovich
- UOC Oncologia di Belluno, Dipartimento di Oncologia Clinica, AULSS 1 Dolomiti, Ospedale S. Martino, Belluno, Italy
| | - Lucia Fratino
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano, Pordenone, Italy
| | - Saverio Cinieri
- Medical Oncology Division and Breast Unit, Senatore Antonio Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Giorgia Negrini
- Oncologia Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Banzi
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Mariella Sorarù
- Medical Oncology, Camposampiero Hospital, USSL15 Alta Padovana, Padova, Italy
| | - Paolo Andrea Zucali
- Department of Oncology, Humanitas Clinical and Research Centre, IRCCS, Rozzano, Milan, Italy, and Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | | | - Antonio Russo
- Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Università degli Studi di Palermo, Palermo, Italy
| | - Nicola Battelli
- UOC Oncologia, Ospedale Generale Provinciale di Macerata, ASUR Marche Area Vasta 3, Macerata, Italy
| | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | | | - Sergio Bracarda
- Struttura Complessa di Oncologia Medica e Traslazionale, Azienda Ospedaliera Santa Maria di Terni, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago, Verona
| | - Debora Pezzuolo
- Medicina oncologica, Ospedale di Guastalla e Correggio, Area Nord, Reggio Emilia, Italy
| | - Lucia Longo
- Unità operativa di Oncologia, Ospedale di Sassuolo, Area Sud dell'Azienda USL di Modena, Sassuolo, Modena, Italy
| | - Donata Sartori
- Oncologia Dolo-Mirano, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Mauro Iannopollo
- Medical Oncology Unit, Dip. Oncology, St Jacopo Hospital, Azienda USL Toscana Centro, Pistoia, Italy
| | | | - Fausto Meriggi
- Oncologia Medica, Fondazione Poliambulanza, Istituto Ospedaliero, Brescia, Italy
| | | | - Claudia Corbo
- UO di Oncologia, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, Benevento, Italy
| | - Angela Gernone
- UO Oncologia Medica Universitaria, Azienda Ospedaliera Policlinico di Bari, Bari, Italy
| | | | - Simona Carnio
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | | | - Claudio Verusio
- Oncologia Medica, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Francesco Atzori
- Medical Oncology, Department of Medical Sciences 'M. Aresu', University Hospital and University of Cagliari, Cagliari, Italy
| | - Francesco Carrozza
- Unità Operativa di Oncologia di Faenza, AUSL Romagna, Faenza, Ravenna, Italy
| | - Stefania Gori
- Medical Oncology Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonino Castro
- Struttura semplice dipartimentale di Oncologia, ASST Franciacorta, Chiari, Brescia, Italy
| | - Sara Pilotto
- Section of Oncology, Department of Medicine, University of Verona and Verona University Hospital Trust, Verona, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | | | | | - Evaristo Maiello
- Medical Oncology, Foundation IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | - Carmine Pinto
- Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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14
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Elmas ÖF, Demirbaş A, Düzayak S, Atasoy M, Türsen Ü, Lotti T. Melanoma and COVID-19: A narrative review focused on treatment. Dermatol Ther 2020; 33:e14101. [PMID: 32734626 DOI: 10.1111/dth.14101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022]
Abstract
Melanoma is the most severe form of skin cancer and its incidence has increased over the past few decades. COVID-19 pandemic affected the diagnosis and management of many diseases including melanoma. In this study, we aimed to provide a review focused on the diagnosis and management of melanoma in the era of COVID-19. A comprehensive search was conducted on PubMed, Web of Science, and Google Scholar databases using the keywords "melanoma," "coronavirus," "COVID 19," and "SARS-CoV-2." The relevant guidelines published by the European Society for Medical Oncology and the National Comprehensive Cancer Network were also included. The current guidelines recommend that surgical interventions for new diagnosis of invasive primary melanoma, patients with postoperative complications, wide resection and sentinel lymph node biopsy for newly diagnosed T3-T4 melanoma, and planned surgical procedures for patients in neo-adjuvant trials should be prioritized. Surgical treatment of T3/T4 melanomas should be prioritized over T1/T2 melanomas except for any melanoma in which large clinical residual lesion is visible. Adjuvant therapies can be postponed for up to 12 weeks depending on the local center circumstances. PD-1 inhibitor monotherapy is recommended for patients starting immunologic therapy. Combination immunotherapy is still considered suitable for patients with higher-risk disease. Encorafenib and binimetinib should be prioritized for patients requiring BRAF-targeted therapy due to the lower chance of symptoms mimicking COVID-19 infection.
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Affiliation(s)
- Ömer Faruk Elmas
- Department of Dermatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | | | - Serkan Düzayak
- Department of Dermatology, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Mustafa Atasoy
- Department of Dermatology, Health Science University, Kayseri City Hospital, Kayseri, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University, Mersin, Turkey
| | - Torello Lotti
- Department of Dermatology, Guglielmo Marconi University, Rome, Italy
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15
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Gambichler T, Reuther J, Scheel CH, Becker JC. On the use of immune checkpoint inhibitors in patients with viral infections including COVID-19. J Immunother Cancer 2020; 8:jitc-2020-001145. [PMID: 32611687 PMCID: PMC7358098 DOI: 10.1136/jitc-2020-001145] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
The present review summarizes up-to-date evidence addressing the frequently discussed clinical controversies regarding the use of immune checkpoint inhibitors (ICIs) in cancer patients with viral infections, including AIDS, hepatitis B and C, progressive multifocal leukoencephalopathy, influenza, and COVID-19. In detail, we provide available information on (1) safety regarding the risk of new infections, (2) effects on the outcome of pre-existing infections, (3) whether immunosuppressive drugs used to treat ICI-related adverse events affect the risk of infection or virulence of pre-existing infections, (4) whether the use of vaccines in ICI-treated patients is considered safe, and (5) whether there are beneficial effects of ICIs that even qualify them as a therapeutic approach for these viral infections.
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Affiliation(s)
- Thilo Gambichler
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Judith Reuther
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Christina H Scheel
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany .,Institute of Stem Cell Research, Helmholtz Center Munich, Neuherberg, Germany
| | - Jürgen Christian Becker
- Translational Skin Cancer Research, German Cancer Consortium (DKTK), Dermatology, University Duisburg-Essen, Essen, Germany,German Cancer Research Center (DKFZ), Heidelberg, Germany
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