Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study.

Autor:	Pinato DJ; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy. Electronic address: david.pinato@imperial.ac.uk., Scotti L; Unit of Cancer Epidemiology, Department of Translational Medicine, CPO-Piemonte, University of Piemonte Orientale, Novara, Italy., Gennari A; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy., Colomba-Blameble E; Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France., Dolly S; Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK., Loizidou A; Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium., Chester J; Medical Oncology, School of Medicine, Cardiff University, Cardiff, UK; Medical Oncology, Velindre Cancer Centre, Cardiff, UK., Mukherjee U; Medical Oncology, Barts Health NHS Trust, London, UK., Zambelli A; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy., Aguilar-Company J; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain., Bower M; Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK., Galazi M; Cancer Division, University College London Hospitals, London, UK., Salazar R; Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain., Bertuzzi A; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy., Brunet J; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain., Mesia R; Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain., Sita-Lumsden A; Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK., Colomba J; Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France., Pommeret F; Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, 114 Rue Edouard Vaillant, 94800, Villejuif, France., Seguí E; Department of Medical Oncology, Hospital Clinic, Barcelona, Spain., Biello F; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy., Generali D; Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy., Grisanti S; Medical Oncology Unit, Spedali Civili, Brescia, Italy., Rizzo G; Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Libertini M; Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy., Moss C; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK., Evans JS; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK., Russell B; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK., Wuerstlein R; Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany., Vincenzi B; Policlinico Universitario Campus Bio-Medico, Rome, Italy., Bertulli R; Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Ottaviani D; Cancer Division, University College London Hospitals, London, UK., Liñan R; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain., Marrari A; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy., Carmona-García MC; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain., Sng CCT; Cancer Division, University College London Hospitals, London, UK., Tondini C; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy., Mirallas O; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain., Tovazzi V; Medical Oncology Unit, Spedali Civili, Brescia, Italy., Fotia V; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy., Cruz CA; Department of Medical Oncology, Hospital Clinic, Barcelona, Spain., Saoudi-Gonzalez N; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain., Felip E; Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain., R Lloveras A; Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain., Lee AJX; Cancer Division, University College London Hospitals, London, UK., Newsom-Davis T; Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK., Sharkey R; Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK., Chung C; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK., García-Illescas D; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain., Reyes R; Department of Medical Oncology, Hospital Clinic, Barcelona, Spain., Sophia Wong YN; Cancer Division, University College London Hospitals, London, UK., Ferrante D; Unit of Cancer Epidemiology, Department of Translational Medicine, CPO-Piemonte, University of Piemonte Orientale, Novara, Italy., Marco-Hernández J; Department of Internal Medicine, Hospital Clinic, Barcelona, Spain., Ruiz-Camps I; Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain., Gaidano G; Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy., Patriarca A; Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore della Carità Hospital, Novara, Italy., Sureda A; Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain., Martinez-Vila C; Fundació Althaia Manresa, Manresa, Spain., Sanchez de Torre A; Hospital Universitario XII de Octubre Madrid, Spain., Rimassa L; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy., Chiudinelli L; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy., Franchi M; Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy., Krengli M; Division of Radiotherapy, Department of Translational Medicine, University of Piemonte Orientale and Azienda Ospedaliera Maggiore Della Carita, Novara, Italy., Santoro A; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy; Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy., Prat A; Department of Medical Oncology, Catalan Institute of Oncology, Badalona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain., Tabernero J; Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain., V Hemelrijck M; Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK., Diamantis N; Medical Oncology, Barts Health NHS Trust, London, UK., Cortellini A; Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy. Electronic address: a.cortellini@imperial.ac.uk.
Jazyk:	angličtina
Zdroj:	European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2021 Jun; Vol. 150, pp. 190-202. Date of Electronic Publication: 2021 Apr 06.
DOI:	10.1016/j.ejca.2021.03.035
Abstrakt:	Background: Despite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU. Methods: We performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19-specific therapy across UK and EU cohorts and evaluated the association of these factors with the risk of adverse outcomes in multivariable Cox regression models. Findings: Compared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (hazard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36-1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%; p < 0.0001; HR, 1.59 [95% CI, 1.33-1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti-COVID-19 therapies including corticosteroids, antivirals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of the patient's age, gender, tumour stage and status; number of comorbidities; COVID-19 severity and receipt of anticancer and anti-COVID-19 therapy. Rates of permanent cessation of anticancer therapy after COVID-19 were similar in the UK and EU cohorts. Interpretation: UK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anticancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti-SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted. Competing Interests: Conflict of interest statement D.J.P. received lecture fees from ViiV Healthcare and Bayer Healthcare, travel expenses from BMS and Bayer Healthcare; consulting fees for MiNA Therapeutics, EISAI, Roche and AstraZeneca and research funding (to the institution) from MSD and BMS. A.P. has declared personal honoraria from Pfizer, Roche, MSD Oncology, Eli Lilly and Daiichi Sankyo; travel, accommodations and expenses paid by Daiichi Sankyo; research funding from Roche and Novartis and a consulting/advisory role for NanoString Technologies, Amgen, Roche, Novartis, Pfizer and Bristol Myers Squibb. T.N-D. has declared a consulting/advisory role for Amgen, Bayer, AstraZeneca, BMS, Boehringer Ingelheim, Eli Lilly, MSD, Novartis, Otsuka, Pfizer, Roche and Takeda; speaker fees from AstraZeneca, MSD, Roche, Takeda and travel, accommodations and expenses paid by AstraZenca, BMS, Boehringer Ingelheim, Lilly, MSD, Otsuka, Roche and Takeda. J.B. has declared a consulting/advisory role for MSD and AstraZeneca. PPS has declared a consulting/advisory role for Sanofi and AbbVie. A.P. has declared a consulting/advisory role for Takeda and Sanofi. MP has declared a consulting/advisory role for Gilead and Bayer. A.G. has declared a consulting/advisory role for Roche, MSD, Eli Lilly, Pierre Fabre, EISAI and Daiichi Sankyo; is on the speaker's bureau for Eisai, Novartis, Eli Lilly, Roche, Teva, Gentili, Pfizer, AstraZeneca, Celgene and Daiichi Sankyo and declared research funds from EISAI, Eli Lilly and Roche. C.M.-V. has received travel grants and other honoraria from BMS, MSD, Novartis and Roche. L.R. received consulting fees from Amgen, ArQule, AstraZeneca, Basilea, Bayer, BMS, Celgene, Eisai, Exelixis, Genenta, Hengrui, Incyte, Ipsen, IQVIA, Lilly, MSD, Nerviano Medical Sciences, Roche, Sanofi and Zymeworks; lecture fees from AbbVie, Amgen, Bayer, Eisai, Gilead, Incyte, Ipsen, Lilly, Merck Serono, Roche and Sanofi; travel expenses from Ipsen and institutional research funding from Agios, ARMO BioSciences, AstraZeneca, BeiGene, Eisai, Exelixis, FibroGen, Incyte, Ipsen, Lilly, MSD, Nerviano Medical Sciences, Roche and Zymeworks. J.T. reports personal financial interest in form of a scientific consultancy role for Array BioPharma, AstraZeneca, Bayer, Boehringer Ingelheim, Chugai, Daiichi Sankyo, F. Hoffmann-La Roche Ltd., Genentech, Inc., HalioDX SAS, Ikena Oncology, IQVIA, Imedex, Lilly, Menarini, Merck Serono, Merus, MSD, Mirati, NeoPhore, Novartis, Orion Biotechnology, Peptomyc, Pfizer, Pierre Fabre, Samsung Bioepis, Sanofi, Seattle Genetics, Servier, Taiho, Tessa Therapeutics and TheraMyc. A.C. received consulting fees from MSD, BMS, AstraZeneca, Roche and speakers' fee from AstraZeneca, MSD, Novartis and Astellas. All the remaining authors have declared no conflicts of interest. (Copyright © 2021 Elsevier Ltd. All rights reserved.)
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