Supportive care in patients with cancer during the COVID-19 pandemic

Aapro, Matti; Lyman, Gary H.; Bokemeyer, Carsten; Rapoport, Bernardo; Mathieson, Nicola; Koptelova, N.; Cornes, Paul; Anderson, Ronald; Gascón, Pere; Kuderer, Nicole M.

doi:10.1016/j.esmoop.2020.100038

Cited by 42 publications

(46 citation statements)

References 78 publications

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“…Intermittent G-CSF treatment may be helpful for patients with grade-4 neutropenia during oral azacitidine treatment. Expert guidelines recommend prophylactic use of G-CSF when the overall risk of febrile neutropenia from a chemotherapy regimen is ≥ 20% of patients [ 27 , 40 ]; the frequency of febrile neutropenia during oral azacitidine treatment did not meet this threshold (12%).…”

Section: Resultsmentioning

confidence: 99%

“…Prophylactic use of G-CSF can reduce the incidence of infection-related mortality in patients with cancer [ 27 ]. Additionally, ASCO and Infectious Diseases Society of America (IDSA) guidelines recommend antibacterial and antifungal prophylaxis for patients who are at high risk of infection, including patients who may be expected to have profound, protracted neutropenia (< 1.0 × 10 9 /L neutrophils for > 7 days) [ 42 ].…”

Section: Resultsmentioning

confidence: 99%

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Management of adverse events in patients with acute myeloid leukemia in remission receiving oral azacitidine: experience from the phase 3 randomized QUAZAR AML-001 trial

et al. 2021

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Background Most older patients with acute myeloid leukemia (AML) who attain morphologic remission with intensive chemotherapy (IC) will eventually relapse and post-relapse prognosis is dismal. In the pivotal QUAZAR AML-001 trial, oral azacitidine maintenance therapy significantly prolonged overall survival by 9.9 months (P < 0.001) and relapse-free survival by 5.3 months (P < 0.001) compared with placebo in patients with AML in first remission after IC who were not candidates for transplant. Currently, the QUAZAR AML-001 trial provides the most comprehensive safety information associated with oral azacitidine maintenance therapy. Reviewed here are common adverse events (AEs) during oral azacitidine treatment in QUAZAR AML-001, and practical recommendations for AE management based on guidance from international cancer consortiums, regulatory authorities, and the authors’ clinical experience treating patients in the trial. Methods QUAZAR AML-001 is an international, placebo-controlled randomized phase 3 study. Patients aged ≥ 55 years with AML and intermediate- or poor-risk cytogenetics at diagnosis, who had attained first complete remission (CR) or CR with incomplete blood count recovery (CRi) within 4 months before study entry, were randomized 1:1 to receive oral azacitidine 300 mg or placebo once-daily for 14 days in repeated 28-day cycles. Safety was assessed in all patients who received ≥ 1 dose of study drug. Results A total of 469 patients received oral azacitidine (n = 236) or placebo (n = 233). Median age was 68 years. Patients received a median of 12 (range 1–80) oral azacitidine treatment cycles or 6 (1–73) placebo cycles. Gastrointestinal AEs were common and typically low-grade. The most frequent grade 3–4 AEs during oral azacitidine therapy were hematologic events. AEs infrequently required permanent discontinuation of oral azacitidine (13%), suggesting they were effectively managed with use of concomitant medications and oral azacitidine dosing modifications. Conclusion Oral azacitidine maintenance had a generally favorable safety profile. Prophylaxis with antiemetic agents, and blood count monitoring every other week, are recommended for at least the first 2 oral azacitidine treatment cycles, and as needed thereafter. Awareness of the type, onset, and duration of common AEs, and implementation of effective AE management, may maximize treatment adherence and optimize the survival benefits of oral azacitidine AML remission maintenance therapy. Trial registration This trial is registered on clinicaltrials.gov: NCT01757535 as of December 2012.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Management of adverse events in patients with acute myeloid leukemia in remission receiving oral azacitidine: experience from the phase 3 randomized QUAZAR AML-001 trial

et al. 2021

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“…The risk of thromboembolic events in oncologic patients affected by COVID-19 seems to be considerably increased, especially in older patients and those with other important comorbidities (including pulmonary illness). 40,41 That is partly due to the cancer itself, once cancer can directly influence the presence of hypercoagulability that is responsible for the clinical events of vascular occlusion. 42 Furthermore, the effects of antineoplastic therapy, supportive drugs, such as steroids, and the immunosuppressive properties of cancer itself might be responsible for this higher thromboembolic risk.…”

Section: Discussionmentioning

confidence: 99%

“…44 Considering that, the European Society for Medical Oncology states that prophylaxis of thromboembolic events should be continued in accordance with existing guidelines. 40 Moreover, proper and preventive measures must be taken to reduce the risk of COVID-19 in patients with cancer, and to effectively manage those who are infected by the virus. These actions are pivotal, since inpatients with cancer infected by SARS-CoV-2 have high chance of mortality.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 (SARS‐CoV‐2) infection and thrombotic conditions: A systematic review and meta‐analysis

Gabbai-Armelin

Oliveira

Ferrisse

et al. 2021

Eur J Clin Investigation

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Background: COVID-19 is an infectious disease caused by SARS-CoV-2 associated with haematological manifestations (thrombolytic events). Aims: Considering the high prevalence of the thrombotic scenarios associated with COVID-19, the aim of this study was to perform a systematic review of the available literature, concerning the relation of COVID-19 and the thrombotic events, and identify prognostic factors for these events. Materials & Methods: PubMed, Web of Science and Scopus databases were searched. Independent reviewers conducted all flow diagram steps. For qualitative analysis, Oxford level of evidence and Newcastle-Ottawa scale were used in the eligible articles. For the prognostic factors, a meta-analysis was conducted to age, number of neutrophils and platelets, and levels of ferritin, C-reactive protein, lactate dehydrogenase and D-dimer. Publication bias was accessed by funnel plot and by trim-and-fill test. Trim-and-fill test was also applied to evaluate meta-analysis bias. Results: Twenty articles were included in the qualitative analysis, and 6 articles were included in the meta-analysis. Case-control studies showed bias related to exposure, and the main bias in cohort studies were related to selection and outcome. All articles received score 4 for the level of evidence. Hypertension and diabetes were the comorbidities more frequently associated with thrombolytic events. Significant results were found regarding D-dimer (P < .0001) and age (P = .0202) for thrombotic events in patients diagnosed with COVID-19. Conclusion: Patients older than 60 years, with hypertension, diabetes and D-Dimer values above 3.17 µg/mL, can be considered prognostic factors for developing thrombotic events due to COVID-19.

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“…The MHRA has advised caution while using ChAdOx1 nCoV-19 in people of any age who are at higher risk of blood clots because of underlying medical conditions [ 40 ]. This guidance could impact patients with cancer, considering that malignancy itself is associated with an increased risk of thromboembolism [ 41 ]. Some countries have restricted the use of this vaccine to older age groups, even though the EMA and MHRA opine that based on data available on 26 May 2021, the benefits outweigh the risks in the majority of people.…”

Section: Covid-19 Vaccines Thrombosis and Low Plateletsmentioning

confidence: 99%

Emerging issues related to COVID-19 vaccination in patients with cancer

et al. 2021

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Coronavirus disease 2019 (COVID-19) has resulted in millions of deaths globally. The pandemic has had a severe impact on oncology care and research. Patients with underlying cancer are more vulnerable to contracting COVID-19, and also have a more severe clinical course following the infection. The rollout of COVID-19 vaccines in many parts of the world has raised hopes of controlling the pandemic. In this editorial, the authors outline key characteristics of the currently approved COVID-19 vaccines, provide a brief overview of key emerging issues such as vaccine-induced immune thrombotic thrombocytopenia and SARS-CoV-2 variants of concern, and review the available data related to the efficacy and side effects of vaccinating patients with cancer.

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Supportive care in patients with cancer during the COVID-19 pandemic

Cited by 42 publications

References 78 publications

Management of adverse events in patients with acute myeloid leukemia in remission receiving oral azacitidine: experience from the phase 3 randomized QUAZAR AML-001 trial

Management of adverse events in patients with acute myeloid leukemia in remission receiving oral azacitidine: experience from the phase 3 randomized QUAZAR AML-001 trial

COVID‐19 (SARS‐CoV‐2) infection and thrombotic conditions: A systematic review and meta‐analysis

Emerging issues related to COVID-19 vaccination in patients with cancer

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