Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium

BACKGROUND

Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies.

PATIENTS AND METHODS

Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients).

RESULTS

A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality.

CONCLUSIONS

Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies.

CLINICAL TRIAL IDENTIFIER

NCT04354701.

A service evaluation of an occupational health Covid-19 referral pathway

Background

A rapid management referral pathway was established by a private UK occupational health (OH) provider to offer assessments and advice on managing individual risk relating to Covid-19 in the workplace.

Aims

The aim of this service evaluation was to assess the utilization and effectiveness of the pathway in supporting referrers during a pandemic.

Methods

Referrals between March–August 2020 were analysed by date and industry to assess service utilization. A survey was sent to a convenience sample of referrers throughout this period, requesting feedback on whether the report led to a change in how the worker was managed, and whether it increased referrer confidence in managing the worker.

Results

Five hundred and seventy referrals were made, predominantly from wholesale and retail; professional, scientific and technical; and food and drink production. There was a small peak of referrals from manufacturing in April and a larger peak in July–August from wholesale and retail, and food and drink production. Of 166 surveys sent, 58 were completed (35% response rate). In 71% of cases, referrers indicated that the report led to change in how the worker was managed, and in 86% of cases, referrers reported being more confident in managing the worker.

Conclusions

The pathway was well-utilized. OH assessments and advice have an important role to play in a pandemic, with useful impact on how workers are managed and how confident managers feel in managing workers.

Sentinel approach to detect emerging causes of work-related respiratory diseases

BACKGROUND

The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD).

AIMS

To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK.

METHODS

Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD.

RESULTS

A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses).

CONCLUSIONS

Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs.

Differential reporting of work-related mental ill-health in doctors

Background

Evidence suggests that the medical profession is reluctant to report mental ill-health despite its high prevalence.

Aims

To compare differential reporting patterns in the incidence of work-related mental ill-health (WRMIH) affecting doctors with selected comparison occupational groups, as determined by surveillance by general practitioners (GPs), specialist psychiatrists and occupational physicians (OPs).

Methods

New cases of medically reported WRMIH were reported prospectively between 2006 and 2009 by GPs, psychiatrists and OPs as part of The Health and Occupation Research (THOR) network. For GP and psychiatry reporting schemes, incidence rates (IRs) for doctors, nurses, teachers, corporate managers and protective service workers were calculated using information from the Labour Force Survey as the denominator. In OP surveys, participating reporters provided denominator information to calculate IRs for doctors, nurses and teachers.

Results

Average annual IRs expressed per 100000 person/years employed as reported by GPs, psychiatrists and OPs, respectively, were: doctors (309, 971, 430), nurses (891, 208, 670), teachers (1040, 136, 210) and for GPs and psychiatrists, respectively, were: protective service workers (1432, 721) and corporate managers (428, 90). Psychiatrists reported a higher incidence of WRMIH in doctors, whereas GPs reported higher incidences of WRMIH in other occupations (chi-squared test, P < 0.001).

Conclusions

The distribution of the incidence of new cases reported across different schemes suggests a differential reporting pattern of WRMIH in doctors. The higher IR for doctors in psychiatrist-reported WRMIH could be due to factors such as disease severity and bypassing formal referral channels.

Abstract PD3-05: Inhibition of fatty-acid oxidation as a therapy for triple-negative breast cancer

Expression of the oncogenic transcription factor MYC is disproportionately elevated in triple-negative breast cancer (TNBC) compared to estrogen, progesterone and/or human epidermal growth factor 2 receptor-positive (RP) breast tumors. We and others have shown that MYC alters metabolism during tumorigenesis. However, the role of MYC in TNBC metabolism remains largely unexplored. We hypothesized that pharmacologic inhibition of MYC-driven metabolic pathways may serve as a therapeutic strategy for this clinically challenging subtype of breast cancer. Using an unbiased metabolomics approach, we identified fatty acid oxidation intermediates as dramatically up-regulated in MYC-driven models of TNBC. A lipid metabolism gene signature was identified in patients with TNBC in the TCGA and multiple other clinical datasets, implicating fatty acid oxidation as a deregulated pathway critical for TNBC metabolism. We find that MYC-overexpressing TNBC, including transgenic models and patient-derived xenografts (PDX), display increased bioenergetic reliance upon fatty-acid oxidation (FAO). Pharmacologic inhibition of FAO catastrophically decreases energy metabolism of MYC over-expressing breast cancer, blocks growth of a MYC-driven transgenic TNBC model and MYC-overexpressing patient-derived xenografts. In vivo inhibition of FAO induced proliferation arrest and increased cell death in PDX models of TNBC. Our results demonstrate that inhibition of FAO is a novel therapeutic strategy against TNBCs that over-express MYC.

Citation Format: Goga A, Camarda R, Zhou AY, Kohnz RA, Balakrishnan S, Anderton B, Mahieu C, Eyob H, Krings G, Nomura DK. Inhibition of fatty-acid oxidation as a therapy for triple-negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD3-05.

Changes in total nitrogen and amino acid composition of New Zealand Undaria pinnatifida with growth, location and plant parts

Undaria pinnatifida is known as unwanted organism in New Zealand. However, Wakame is a traditional food made of U. pinnatifida, which is now cultured extensively in East Asia. Therefore, it is important to examine this introduced alga as a potential source of dietary protein for human consumption in New Zealand. This study determined total nitrogen content and amino acid profile of New Zealand U. pinnatifida harvested from the Marlborough Sounds on a monthly basis from June to November 2011. Total average nitrogen content and crude protein content was 21.02 mg/g dry weight and 13.1% of dry weight, respectively. The three most abundant amino acids that contributed to flavour (glutamic acid, aspartic acid and alanine) were present and the most abundant essential amino acids were arginine, leucine, lysine and valine. The results showed that the amino acid content in blades from the exposed farm was significantly higher (P < 0.05) than the others. Sporophyll maturation of U. pinnatifida in New Zealand influenced protein content and amino acid composition. Sporophyll, considered as a waste product by many, was found to be a potentially good source of protein.

TRAF2 is an NF-κB-activating oncogene in epithelial cancers

Aberrant NF-κB activation is frequently observed in human cancers. Genome characterization efforts have identified genetic alterations in multiple components of the NF-κB pathway, some of which have been shown to be essential for cancer initiation and tumor maintenance. Here using patient tumors and cancer cell lines, we identify the NF-κB regulator, TRAF2 as an oncogene that is recurrently amplified and rearranged in 15% of human epithelial cancers. Suppression of TRAF2 in cancer cells harboring TRAF2 copy number gain inhibits proliferation, NF-κB activation, anchorage-independent growth and tumorigenesis. Cancer cells that are dependent on TRAF2 also require NF-κB for survival. The phosphorylation of TRAF2 at serine 11 is essential for the survival of cancer cells harboring TRAF2 amplification. Together these observations identify TRAF2 as a frequently amplified oncogene.