Coronavirus Disease 2019 Infection in a Patient Population with Lung Cancer: Incidence, Presentation, and Alternative Diagnostic Considerations

Piper-Vallillo, Andrew J.; Mooradian, Meghan J.; Meador, Catherine B.; Yeap, Beow Y.; Peterson, Jennifer; Sakhi, Mustafa; Do, Andrew; Zubiri, Leyre; Stevens, Sara E.; Vaughn, Jeanne; Goodwin, Kelly; Gavralidis, Alexander; Willers, Henning; Miller, Adam; Farago, Anna F.; Piotrowska, Zofia; Lin, Jessica J.; Dagogo‐Jack, Ibiayi; Lennes, Inga T.; Sequist, Lecia V.; Temel, Jennifer S.; Heist, Rebecca S.; Digumarthy, Subba R.; Reynolds, Kerry L.; Gainor, Justin F.

doi:10.1016/j.jtocrr.2020.100124

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…Additionally, the overall in-hospital mortality among hospitalized patients was found to be 13.7%, with patients in the prior diagnosis group demonstrating a higher rate of mortality compared to those patients diagnosed within the ED. This mortality is slightly lower than previously described findings in the literature; however, given our small sample size, it is less surprising that this difference arose [ 2 , 4 , 13 , 14 ]. While these findings may be attributed to the timing of disease, with patients diagnosed in the ED able to receive supportive therapy at an earlier time course compared to those diagnosed outside the ED, it is still important for radiologists and emergency physicians to be aware of these differences.…”

Section: Discussioncontrasting

confidence: 62%

COVID-19 infection in the cancer population: a study of emergency department imaging utilization and findings

et al. 2021

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Purpose To analyze emergency department (ED) computerized tomography (CT) utilization in cancer patients with coronavirus disease 2019 (COVID-19). Methods A retrospective chart review was performed to identify cancer patients who received COVID-19 diagnosis within the single healthcare system and presented to the ED within 30 days of COVID-19 positive date between May 1 and December 31, 2020. Results In our 61 patients, the mean age was 72.5 years old, with 34% of patients ( n = 21) on active cancer therapy and 66% ( n = 40) on surveillance only. Most patients ( n = 53) received their COVID-19 diagnosis within the ED, with 8 patients diagnosed prior to initial ED visit. The most common CT studies ordered within the ED were CT chest ( n = 25), CT abdomen/pelvis (A/P) ( n = 20), CT head ( n = 8), and CT chest/abdomen/pelvis (C/A/P) ( n = 7). COVID-19 findings were present on 33 scans, findings of worsening malignancy on 12 scans, and non-COVID non-cancer findings on 9 scans. Significant differences in CT severity score ( p = 0.0001), indication for hospitalization ( p = 0.026), length of hospitalization ( p = 0.004), interventions (remdesivir, mechanical ventilation, and vasopressor support) while hospitalized ( p < 0.05), and mortality ( p = 0.042) were found between the prior diagnosis and ED diagnosis groups. No such differences were found between the active treatment and surveillance groups. Conclusion ED CT imaging findings in patients with cancer and COVID-19 are predominantly related to COVID-19 infection, rather than cancer history or anti-cancer therapy status.

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Section: Discussioncontrasting

confidence: 62%

COVID-19 infection in the cancer population: a study of emergency department imaging utilization and findings

et al. 2021

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“…14 Considering clinical spectrum and potential overlap of LC symptoms and radiological findings with COVID-19 disease, the differential diagnosis may be complicated and challenging. 15 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario

et al. 2022

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Introduction Coronavirus disease 2019 (COVID-19) has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak impacted on access to cancer diagnosis and treatment for LC pts compared to pre-pandemic time. Methods Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared to the same period in 2019. Differences between the two years were analyzed using chi-square test for categorical variables and Mann-Whitney U test for continuous variables. Results A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 vs 1637, p=0.09). Newly LC pts in 2020 were more likely to be diagnosed with stage IV disease (p<0.01) and to be current smokers (p<0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% vs -3.2%) compared to the other months included. More LC pts referred to low/medium volume hospital in 2020 compared to 2019 (p=0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (p=0.94), symptoms onset and cytohistological diagnosis (p=0.92), symptoms onset and treatment start (p=0.40), treatment start and first radiological revaluation (p=0.36). Conclusions Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.

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“…Of note, this study period spanned the COVID-19 pandemic. 31 During the pandemic, the protocol was amended to allow bevacizumab infusions to be held in the absence of toxicity at the investigator’s discretion, to minimize patient exposures.…”

Section: Methodsmentioning

confidence: 99%

Safety and activity of alectinib plus bevacizumab in patients with advanced ALK-rearranged non-small-cell lung cancer: a phase I/II study

et al. 2022

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Background Alectinib, a second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI), is highly effective in advanced ALK -rearranged non-small-cell lung cancer and represents a standard first-line therapy. New strategies are needed, however, to delay resistance. We conducted a phase I/II study to assess the safety and efficacy of combining alectinib with bevacizumab, a monoclonal antibody against vascular endothelial growth factor. Patients and methods Patients with advanced ALK -rearranged non-squamous non-small-cell lung cancer were enrolled. The phase I portion employed a dose de-escalation strategy with alectinib and bevacizumab starting at the individual standard doses. The primary objective was to determine the recommended phase II dose (RP2D). In phase II, the primary objective was to evaluate the safety of the combination at the RP2D; the secondary objective was to determine extracranial and intracranial efficacy. Results Eleven patients were enrolled between September 2015 and February 2020. Most patients (82%) had baseline brain metastases. Six patients (55%) were treatment-naive; five (46%) had received prior ALK TKIs (crizotinib, n = 3; ceritinib, n = 1; crizotinib then brigatinib, n = 1). No dose-limiting toxicities occurred. RP2D was determined as alectinib 600 mg orally twice daily plus bevacizumab 15 mg/kg intravenously every 3 weeks. Three patients experienced grade 3 treatment-related adverse events: pneumonitis related to alectinib, proteinuria related to bevacizumab, and hypertension related to bevacizumab. Treatment-related intracranial hemorrhage was not observed. Six (100%) of six treatment-naive patients and three (60%) of five ALK TKI-pretreated patients had objective responses; median progression-free survival was not reached (95% confidence interval, 9.0 months-not reached) and 9.5 months (95% confidence interval, 4.3 months-not reached), respectively. Intracranial responses occurred in four (100%) of four treatment-naive and three (60%) of five TKI-pretreated patients with baseline brain metastases. The study was stopped prematurely because of slow accrual. Conclusions Alectinib plus bevacizumab was well tolerated without unanticipated toxicities or dose-limiting toxicities.

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Coronavirus Disease 2019 Infection in a Patient Population with Lung Cancer: Incidence, Presentation, and Alternative Diagnostic Considerations

Cited by 7 publications

References 15 publications

COVID-19 infection in the cancer population: a study of emergency department imaging utilization and findings

COVID-19 infection in the cancer population: a study of emergency department imaging utilization and findings

Evaluation of COVID-19 impact on DELAYing diagnostic-therapeutic pathways of lung cancer patients in Italy (COVID-DELAY study): fewer cases and higher stages from a real-world scenario

Safety and activity of alectinib plus bevacizumab in patients with advanced ALK-rearranged non-small-cell lung cancer: a phase I/II study

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