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Safety of systemic anti-cancer treatment in oncology patients with non-severe COVID-19: a cohort study
C van Marcke1,2, N Honoré1,2, A van der Elst1,2
1Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Background:
The viral pandemic coronavirus disease 2019 (COVID-19) has disrupted cancer patient management around the world. Most reported data relate to incidence, risk factors, and outcome of severe COVID-19. The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is an important matter in daily practice.
Methods:
ONCOSARS-1 was a single-center, academic observational study. Adult patients with solid tumors treated in the oncology day unit with systemic anti-cancer therapy during the initial phase of the COVID-19 pandemic in Belgium were prospectively included. All patients (n = 363) underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) serological testing after the first peak of the pandemic in Belgium. Additionally, 141 of these patients also had a SARS-CoV-2 RT-PCR test during the pandemic. The main objective was to retrospectively determine the safety of systemic cancer treatment, measured by the rate of adverse events according to the Common Terminology Criteria for Adverse Events, in SARS-CoV-2-positive patients compared with SARS-CoV-2-negative patients.
Results:
Twenty-two (6%) of the 363 eligible patients were positive for SARS-CoV-2 by RT-PCR and/or serology. Of these, three required transient oxygen supplementation, but none required admission to the intensive care unit. Hematotoxicity was the only adverse event more frequently observed in SARS-CoV-2 -positive patients than in SARS-CoV-2-negative patients: 73% vs 35% (P < 0.001). This association remained significant (odds ratio (OR) 4.1, P = 0.009) even after adjusting for performance status and type of systemic treatment. Hematological adverse events led to more treatment delays for the SARS-CoV-2-positive group: 55% vs 20% (P < 0.001). Median duration of treatment interruption was similar between the two groups: 14 and 11 days, respectively. Febrile neutropenia, infections unrelated to COVID-19, and bleeding events occurred at a low rate in the SARS-CoV-2-positive patients.
Conclusion:
Systemic anti-cancer therapy appeared safe in ambulatory oncology patients treated during the COVID-19 pandemic. There were, however, more treatment delays in the SARS-CoV-2-positive population, mainly due to a higher rate of hematological adverse events.
Insights
Systemic anti-cancer therapy is safe for ambulatory oncology patients during COVID-19. However, SARS-CoV-2-positive patients experienced more treatment delays due to higher rates of hematological adverse events.
Area of Science:
- Oncology
- Infectious Diseases
- Clinical Research
Background:
- The COVID-19 pandemic significantly disrupted global cancer patient management.
- Data primarily focused on severe COVID-19 outcomes, leaving a gap in understanding non-severe COVID-19 impacts on cancer treatment.
- The safety of systemic anti-cancer therapy in oncology patients with non-severe COVID-19 is crucial for clinical practice.
Purpose of the Study:
- To evaluate the safety of systemic anti-cancer therapy in oncology patients during the COVID-19 pandemic.
- To compare adverse events in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-positive cancer patients versus SARS-CoV-2-negative patients.
- To identify specific safety concerns and treatment modifications needed for cancer patients with COVID-19.
Main Methods:
- An observational study (ONCOSARS-1) included adult patients with solid tumors receiving systemic anti-cancer therapy.
- Patients underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing (serology and/or RT-PCR).
- Adverse events were assessed using Common Terminology Criteria for Adverse Events (CTCAE) and compared between SARS-CoV-2-positive and negative groups.
Main Results:
- 6% of patients tested positive for SARS-CoV-2; none required intensive care unit admission.
- Hematotoxicity was significantly higher in SARS-CoV-2-positive patients (73% vs. 35%, P < 0.001).
- Treatment delays were more frequent in SARS-CoV-2-positive patients (55% vs. 20%, P < 0.001) due to hematological adverse events.
Conclusions:
- Systemic anti-cancer therapy is generally safe for ambulatory oncology patients during the COVID-19 pandemic.
- SARS-CoV-2 infection is associated with an increased risk of hematological adverse events and subsequent treatment delays.
- Careful monitoring for hematotoxicity is essential in oncology patients undergoing treatment during viral pandemics.
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