COVID-19 infection among patients with cancer in Australia from 2020 to 2022: a national multicentre cohort study

Background

The global COVID-19 pandemic disproportionately affected certain populations and its management differed between countries. This national study describes characteristics and outcomes of COVID-19 in patients with cancer in Australia.

Methods

We performed a multicentre cohort study of patients with cancer and COVID-19 from March 2020 to April 2022. Data were analysed to determine varying characteristics between cancer types and changes in outcomes over time. Multivariable analysis was performed to determine risk factors associated with oxygen requirement.

Findings

620 patients with cancer from 15 hospitals had confirmed COVID-19. There were 314/620 (50.6%) male patients, median age 63.5 years (IQR 50-72) and majority had solid organ tumours (392/620, 63.2%). The rate of COVID-19 vaccination (≥1 dose) was 73.4% (455/620). Time from symptom onset to diagnosis was median 1 day (IQR 0-3), patients with haematological malignancy had a longer duration of test positivity. Over the study period, there was a significant decline in COVID-19 severity. Risk factors associated with oxygen requirement included male sex (OR 2.34, 95% CI 1.30-4.20, p = 0.004), age (OR 1.03, 95% CI 1.01-1.06, p = 0.005); not receiving early outpatient therapy (OR 2.78, 95% CI 1.41-5.50, p = 0.003). Diagnosis during the omicron wave was associated with lower odds of oxygen requirement (OR 0.24, 95% CI 0.13-0.43, p < 0.0001).

Interpretation

Outcomes from COVID-19 in patients with cancer in Australia over the pandemic have improved, potentially related to changing viral strain and outpatient therapies.

Funding

This study was supported by research funding from MSD.

Abstract OT2-10-01: A phase 2, randomized study of magrolimab combination therapy in adult patients with unresectable locally advanced or metastatic triple-negative breast cancer

Background: Improving outcomes for patients (pts) with triple-negative breast cancer (TNBC) remains a high unmet need. Immune checkpoint inhibitors (ICIs) + chemotherapy (chemo) and single-agent sacituzumab govitecan, a trophoblast cell-surface antigen 2–targeted antibody-drug conjugate coupled to SN38 via a proprietary, hydrolysable linker, are approved in newly diagnosed pts with programmed death-ligand 1 (PD-L1)–positive tumors and pts who received ≥2 prior systemic therapies (≥1 for metastatic disease), respectively. However, additional options are urgently needed, particularly for pts with tumors that do not express PD-L1 and for those with progression on chemo ± ICI. Magrolimab is an antibody blocking CD47, a “don’t eat me” signal overexpressed on cancer cells, including TNBC, inducing tumor phagocytosis by macrophages. Magrolimab has shown preclinical activity and promising clinical efficacy in hematologic and solid tumors. Chemo agents, including taxanes, can enhance prophagocytic signals on tumor cells, leading to the potential for synergistic antitumor activity with magrolimab. This study is evaluating the safety/tolerability and efficacy of magrolimab in combination with nab-paclitaxel/paclitaxel or with sacituzumab govitecan in unresectable locally advanced/metastatic TNBC. Trial Design: This open-label, 2-cohort (C) study consists of safety run-in and phase (ph)2 portions evaluating nab-paclitaxel/paclitaxel (choice) + magrolimab (safety run-in) or ± magrolimab (ph2, randomized 1:1) in pts with untreated, advanced/metastatic TNBC ineligible for ICI (C1) and magrolimab + sacituzumab govitecan (safety run-in and ph2) in pts with advanced TNBC who received 1 prior systemic treatment in the metastatic setting (C2). Stratification factors for C1 are neoadjuvant and/or adjuvant taxane therapy, liver metastases, and nab-paclitaxel vs paclitaxel. In both cohorts, magrolimab will be administered intravenously (IV) in de-escalating doses to establish the recommended ph2 dose (RP2D). Nab-paclitaxel/paclitaxel and sacituzumab govitecan will be administered IV per standard of care. Eligibility Criteria: Eligible pts are ≥18 y with PD-L1–negative, untreated, unresectable locally advanced/metastatic TNBC (C1) or unresectable locally advanced/metastatic TNBC who received 1 prior line of therapy in the advanced setting, including a taxane and an ICI if PD-L1 positive (C2), with measurable disease per RECIST v1.1. Exclusion criteria include active central nervous system disease, red blood cell transfusion dependence, or prior treatment with CD47/signal regulatory protein α–targeting agents for both cohorts. Additional exclusions are disease progression within 6 months of (neo)adjuvant therapy or rapid visceral progression and/or symptomatic disease, for which single-agent chemo would not be appropriate (C1); chronic inflammatory bowel disease and a history of bowel obstruction or gastrointestinal perforation within 6 months of enrollment, prior treatment with topoisomerase I inhibitors or antibody-drug conjugates containing a topoisomerase inhibitor, and receipt of high-dose systemic corticosteroids within 2 weeks of cycle 1 day 1 (C2). Specific Aims: The primary objectives are safety/tolerability and magrolimab RP2D (safety run-in) and efficacy (ph2: C1, progression-free survival [PFS]; C2, objective response rate [ORR]; both by investigator). Secondary objectives include ORR, PFS, and duration of response by investigator and independent central review, overall survival, and magrolimab concentration vs time and antidrug antibodies. Present and Target Accrual: The study is enrolling in the US, Australia, and Hong Kong. Target accrual is 144 pts. Contact Information: ClinicalTrials.gov: NCT04958785.

Citation Format: Natalie Rainey, Rohit Joshi, Joanne Win Yang Chiu, Ann Chen, Hao Wang, Jared Odegard, Michael Howland, Sylvia Adams. A phase 2, randomized study of magrolimab combination therapy in adult patients with unresectable locally advanced or metastatic triple-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-10-01.

Molecular classification of hormone-sensitive and castration-resistant prostate cancer, using nonnegative matrix factorization molecular subtyping of primary and metastatic specimens

BACKGROUND

Despite the rapidly evolving therapeutic landscape, immunotherapy has demonstrated limited activity in prostate cancer. A greater understanding of the molecular landscape, particularly the expression of immune-related pathways, will inform future immunotherapeutic strategies. Consensus nonnegative matrix factorization (cNMF) is a novel model of molecular classification analyzing gene expression data, focusing on biological interpretation of metagenes and selecting meaningful clusters.

OBJECTIVE

We aimed to identify molecular subtypes of prostate cancer using cNMF and correlate these with existing biomarkers to inform future immunotherapeutic strategies.

METHODS

A cohort of archival tumor specimens from hormone-sensitive and castration-resistant disease was studied. Whole transcriptomic profiles were generated using TruSeq RNA Access technology and subjected to cNMF. Comprehensive genomic profiling was performed with the FoundationOne assay. NMF subtypes were characterized by gene expression pathways, genomic alterations and correlated with clinical data, then applied to The Cancer Genome Atlas data set.

RESULTS

We studied 164 specimens, including 52 castration-resistant and 13 paired primary/metastatic specimens. cNMF identified four distinct subtypes. NMF1 (19%) is enriched for immune-related and stromal-related pathways with transforming growth factor β (TGFβ) signature. NMF2 (36%) is associated with FOXO-mediated transcription signature and AKT signaling, NMF3 (26%) is enriched for ribosomal RNA processing, while NMF4 (19%) is enriched for cell cycle and DNA-repair pathways. The most common gene alterations included TMPRSS22 (42%), TP53 (23%), and DNA-repair genes (19%), occurring across all subtypes. NMF4 is significantly enriched for MYC and Wnt-signaling gene alterations. TMB, CD8 density, and PD-L1 expression were low overall. NMF1 and NMF4 were NMF2 was associated with superior overall survival.

CONCLUSIONS

Using cNMF, we identified four molecularly distinct subtypes which may inform treatment selection. NMF1 demonstrates the most inflammatory signature with asuppressive TGFβ signature, suggesting potential benefit with immunotherapy combination strategies targeting TGFβ and PD-(L)1. Prospective studies are required to evaluate the use of this novel model to molecularly stratify patients for optimal treatment selection.

Administration of immune checkpoint inhibitors using teleoncology model of care in Far North Queensland: A multicenter review of safety outcomes

2084

Background: The Teleoncology model of care, as developed and implemented across health services in Far North Queensland (Australia), improves access to specialist oncology services, including telehealth supervised administration of Oncology drugs for patients in rural/remote towns. There is limited published data regarding the safety of checkpoint inhibitor immunotherapy when it is administered via Teleoncology. Aim: Evaluate safety of immunotherapy administration via Teleoncology, including immune-related adverse events (irAE), treatment delays, hospital admissions and interhospital transfers, in comparison to a retrospective control population. Methods: Retrospective review of all patients treated with immunotherapy via Teleoncology as part of Cairns and Hinterland Hospital and Health Service (CHHHS) and the Townsville Teleoncology Network (TTN) between January 2015 and April 2019. A retrospective cohort treated at Townsville Cancer Centre over the same time period was used as a control group. Results: Fifty-one patients received a total of 624 cycles of immunotherapy (all single agent anti-PD-1/L-1) via Teleoncology. The control population included 142 patients who received 1697 cycles of immunotherapy. Baseline characteristics were well matched between groups. Compared to the control population, patients treated via telehealth did not have statistically significant differences in the rate of Grade 3+ irAE (13.7% v 8%), hospital admissions (13.7% v 7.4%) or protocol suspensions due to immune toxicity (16% v 10%). One patient with Grade 3+ irAE required interhospital transfer for investigation and management, which occurred within 24 hours of presentation to hospital. There were no treatment-related mortalities in either group. Conclusions: Checkpoint inhibitor immunotherapy can safely be delivered using the Teleoncology model of care in rural and remote centres. The incidence of toxicity for single agent immunotherapy was predictably low and not significantly different between groups, however the numbers in this retrospective study were small. The time to recognition and management of immune mediated toxicity in rural and remote centres is an important factor that was not assessed in this study and will be considered in future work.

Enhancing Chemotherapy Capabilities in Rural Hospitals: Implementation of a Telechemotherapy Model (QReCS) in North Queensland, Australia

Introduction:

The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model.

Methods:

Details of implementation and patients’ clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively.

Results:

After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care.

Conclusion:

Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.