Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), was first identified in 2019 in Wuhan, China, and has rapidly spread across the world. As of April 2021, SARS-CoV-2 has infected more than 140,000,000 and caused more than 3,000,000 deaths globally. In November 2020, the monoclonal antibody bamlanivimab was approved by the FDA for non-hospitalized patients with SARS-CoV-2 (COVID-19) who possessed risk factors for progression to severe COVID-19. This provided a treatment option that may help prevent hospitalization. Methods Patients who regularly received ambulatory care at a military treatment facility and who were diagnosed with mild-to-moderate COVID-19 and possessed risk factors for progression to severe COVID-19 were treated with a single, intravenous infusion (700 mg) of the virus-neutralizing monoclonal antibody bamlanivimab. The primary outcome was improvement of self-reported symptoms within 24 to 72 hours of receiving the infusion. The secondary outcome was prevention of disease progression requiring emergency department (ED) utilization or hospitalization related to COVID-19 within 30 days of infusion. Bamlanivimab was administered in accordance with the FDA’s approval and Defense Health Agency’s guidance, including follow-up within 72 hours of administration. Institutional Review Board (IRB) approval was obtained. Results Of the COVID-19 patients who were given the option of a bamlanivimab infusion, 40 accepted and 6 did not (40/46, 86.9%). Thirty-six of 40 patients in the treatment group were contacted within 72 hours. ED/hospitalization information was available for all 46 patients. In the treatment group, 94.4% (34/36) reported global improvement. Three of 40 (7.5%) patients in the treatment group required inpatient admission, and 2 of 40 patients (5%) required ED evaluation within 30 days of infusion. Therefore, 5 of 40 (12.5%) patients required evaluation shortly after infusion, while 2 of 6 (33.3%) patients who declined treatment required hospital evaluation or admission related to COVID-19 within 30 days of infusion (P = .15). Conclusions Global improvement of symptoms within 24 to 72 hours of infusion was reported by 94.4% of patients receiving bamlanivimab; however, statistical significance could not be determined due to the small sample size and lack of placebo group due to study design. Furthermore, ED visits and hospital admissions were analyzed, but with only six patients in the comparison group, the relative risk was not statistically significant and could not be precisely estimated. In the future, this study can be replicated with both larger control/treatment arms to validate the initial results of this small, retrospective, cohort study.
A 92-year-old male presented from an outside hospital for treatment of a chronic obstructive pulmonary disease exacerbation (COPD) and subsequently developed worsening abdominal distention with pain during the course of his hospitalization. He was found to have a high-grade large-bowel obstruction with a dilated colon of 20 cm measuring upward. The patient ultimately underwent a hemicolectomy to prevent bowel ischemia and reformation of another volvulus. We present this case to elucidate the need for vigilant monitoring in patients with chronic bowel obstruction due to lack of typical symptoms, to demonstrate a successful management approach, and to exhibit an extreme example of the resulting megacolon.
e20603 Background: 75% of CRC patients (pts) are age 65 and older. The ability of ECOG PS and age to predict underlying frailty in older pts has been questioned. This prospective multi-center observational study explores the association between EGOG PS, age and a comprehensive geriatric assessment (CGA) in older CRC pts. Methods: CRC pts aged 65 and older who were eligible for chemotherapy based on disease characteristics are being prospectively enrolled. ECOG PS and CGA measures, including functional status, cognition, comorbidity, and affect, were obtained prior to initiation of chemotherapy using validated, standardized measures. Results: 35 elderly CRC pts enrolled between March 2006 and December 2008. Age: 65–69 46%, 70–74 23%, 75–79 11%, >80 20%; gender: female 65%; race: Caucasian 52%, African-American 46%; stage IV disease: 80%. Baseline ECOG PS: 0 60%, 1 32%, 2 8%. Age did not correlate with any components of the CGA except for dependence in any ADLs (rho 0.4, p=0.03). Associations between the components of the CGA and ECOG PS are shown in the table . Conclusions: Neither biologic age nor ECOG PS were robust proxies for rigorously measured functional status in this elderly CRC cohort. This was especially true for the ECOG 0 and 1 pts where, for example, 80% of the ECOG 0 pts had impaired performance on the Short Physical Performance Battery. Work on this expanding cohort is ongoing to determine correlations with these assessments and the ability to tolerate and complete prescribed chemotherapy regimens. If predictive, the CGA could help better target established geriatric interventions to those elderly pts at greatest risk regardless of their age or performance status. [Table: see text] No significant financial relationships to disclose.
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