Since Coronavirus Disease 2019 (COVID-19) was declared pandemic in March 2020, there have been 545.226.550 cases up to 4 July 2022 (1). Several studies concluded that patients (pts) with cancer are at increased risk of COVID-19 infection, morbidity and mortality. Those undergoing neoadyuvant treatment are at particularly risk of disease progression if chemotherapy or surgery are delayed. Also, is known that a higher NLR (neutrophil to limphocyte ratio) is related to worse outcomes (3). Our hospital is located at the Northwest of Spain and in the last months we noticed a never seen number of infections in cancer population. The aim of this study is to evaluate the severity of COVID-19 and its impact on chemotherapy and surgery delay in pts undergoing neoadjuvant chemotherapy breast cancer.
METHODS: We conducted a ambispective, unicenter, observational study of breast cancer pts, treated with neoadjuvant chemotherapy, between March 2020 and May 2022 at University Hospital A Coruña (Spain). We analyzed type of infection, need of hospitalization, chemotherapy and surgical delay, and its association with tumor type; BRCA germline mutation; clinical stage; treatment; vaccination status; and neutrophils, lymphocytes, and NLR before COVID-19 disease.
RESULTS: During the study period, from 1 March 2020 to 31 May 2022, 183 pts underwent neoadjuvant chemotherapy. A total of 23 (12.5%) pts experienced COVID-19 infection, of which 21 were diagnosed between January and May 2022. The median age was 47,91 years [range 33 – 69 years]. Luminal B HER 2 negative comprised the most common molecular subtype (40.9%), followed by Triple Negative (36.4%), Luminal B HER 2 positive (13.6%), and HER 2 enriched (9.1%). Germline mutations in BRCA account for 13.6% pts. At diagnosis, 4.5%, 72.7%, and 22.7% had stages I, II, and III respectively. Chemotherapy treatments included: paclitaxel followed by Adryamicine-Cyclophosphamide (AC) (45.4%); carboplatin – paclitaxel – trastuzumab - pertuzumab (18,2%); carboplatin – paclitaxel followed by AC (18,2%); KEYNOTE-756: pembrolizumab/placebo - paclitaxel followed by AC (13.7%); and paclitaxel – trastuzumab – pertuzumab followed by myocet – cyclophosphamide – trastuzumab - pertuzumab (4.5%). The association of G-CSF ocurred in 9 pts (40.9%). 22 pts were fully vaccinated, 8 pts (36.4%) with two doses and 13 pts (59.1%) with three doses. 77.3% pts experienced mild respiratory symptoms with 9.1% hospitalizations. The median duration of delays was 15 days for chemotherapy and 29,58 days for surgery.
NLR percentil 25 was associated with COVID-19 type of infection. For those pts with a lower rate, infection was asymptomatic and for those with a higher rate symptoms were moderate (Χ2= 5,119, p = 0,024).
CONCLUSIONS: COVID-19 disease become a high prevalent infection in pts undergoing neoadjuvant breast cancer chemotherapy. Most pts are fully vaccinated and experienced an indolent infection. NLR is an easily measurable and cost-effective parameter that could be useful as a prognostic marker of severity in COVID-19. We will continue to follow-up these pts to see the impact of chemotherapy or surgery delay in pathological complete response and disease-free survival until the congress in December 2022.
BIBLIOGRAPHY:
1. WHO Coronavirus (COVID-19) Dashboard [Internet]. world health organization. 2022 [3rd July 2022]. Disponible en: https://covid19.who.int.
2. YekedÜz E, Utkan G, ÜrÜn Y. A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19 [Internet]. European Journal of Cancer. 2020. [24th June 2022]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538140/pdf/main.pdf
3. Jimeno S, Ventura PS, Castellano JM, García-Adasme SI, Miranda M, Touza P, et al. Prognostic implications of neutrophil-lymphocyte ratio in COVID-19 [Internet]. Eur J Clin Invest. 2021. [22th June 2022]. Disponible en: https://onlinelibrary.wiley.com/doi/10.1111/eci.13404.
Table 1: Clinical characteristics of patients
Table 2: Blood cell count in percentils
Citation Format: Beatriz Alonso de Castro, Igor Gomez-Randulfe Rodriguez, Sofia Silva Diaz, Cristina Reboredo, Silvia Antolin Novoa, Eva Perez Lopez, Patricia Cordeiro, Rocio Lesta, Iria Parajo Vazquez, Lourdes Calvo. NEOADYUVANT TREATMENT IN THE COVID ERA [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-39.
