Background: Cancer treatment with anthracyclines may lead to an increased incidence of cardiac disease due to cardiotoxicity, as they may cause irreversible myocardial fibrosis. So far, the proposed methods for screening patients for cardiotoxicity have led to only limited success, while the analysis of myocardial extracellular volume (mECV) at cardiac magnetic resonance (CMR) has shown promising results, albeit requiring a dedicated exam. Recent studies have found strong correlations between mECV values obtained through computed tomography (CT), and those derived from CMR. Thus, our purpose was to evaluate the feasibility of estimating mECV on thoracic contrast-enhanced CT performed for staging or follow-up in breast cancer patients treated with anthracyclines, and, if feasible, to assess if a rise in mECV is associated with chemotherapy, and persistent over time.Methods: After ethics committee approval, female patients with breast cancer who had undergone at least 2 staging or follow-up CT examinations at our institution, one before and one shortly after the end of chemotherapy including anthracyclines were retrospectively evaluated. Patients without available haematocrit, with artefacts in CT images, or who had undergone radiation therapy of the left breast were excluded. Follow-up CT examinations at longer time intervals were also analysed, when available. mECV was calculated on scans obtained at 1, and 7 min after contrast injection.Results: Thirty-two female patients (aged 57±13 years) with pre-treatment haematocrit 38%±4%, and ejection fraction 64%±6% were analysed. Pre-treatment mECV was 27.0%±2.9% at 1 min, and 26.4%±3.8% at 7 min, similar to values reported for normal subjects in the literature. Post-treatment mECV (median interval: 89 days after treatment) was 31.1%±4.9%, and 30.0%±5.1%, respectively, values significantly higher than pre-treatment values at all times (P<0.005). mECV at follow-up (median interval: 135 days after post-treatment CT) was 31.0%±4.5%, and 27.7%±3.7%, respectively, without significant differences (P>0.548) when compared to post-treatment values.Conclusions: mECV values from contrast-enhanced CT scans could play a role in the assessment of myocardial condition in breast cancer patients undergoing anthracycline-based chemotherapy. CT-derived ECV could be an imaging biomarker for the monitoring of therapy-related cardiotoxicity, allowing for potential secondary prevention of cardiac damage, using data derived from an examination that could be already part of patients' clinical workflow.

In the general population, the incidence of thromboembolic events is 117 cases/100,000 inhabitants/year, while in cancer patient incidence, it is four-fold higher, especially in patients who receive chemotherapy and who are affected by pancreatic, lung or gastric cancer. At the basis of venous thromboembolism (VTE) there is the so-called Virchow triad, but tumor cells can activate coagulation pathway by various direct and indirect mechanisms, and chemotherapy can contribute to VTE onset. For these reasons, several studies were conducted in order to assess efficacy and safety of the use of anticoagulant therapy in cancer patients, both in prophylaxis setting and in therapy setting. With this review, we aim to record principal findings and current guidelines about thromboprophylaxis in cancer patients, with particular attention to subjects with additional risk factors such as patients receiving chemotherapy or undergoing surgery, hospitalized patients for acute medical intercurrent event and patients with central venous catheters. Nonetheless we added a brief insight about acute and maintenance therapy of manifested venous thromboembolism in cancer patients.

Background: Pandemic COVID-19 by SARS-CoV-2 infection is facilitated by the ACE2 receptor and protease TMPRSS2. Patients with cancer may be at particularly high risk for SARS-CoV-2 infection and deleterious outcomes to the disease. A better understanding of potential host risk factors, notably ACE2 and TMPRSS2, in malignant tissues may inform considerations surrounding SARS-CoV-2 and COVID-19 in patients with cancer and more broadly in the general population.Methods: We performed a large-scale integrated study of ACE2 and TMPRSS2 gene expression in 10,038 patients with cancer across and within organ systems, by normal versus tumor. We investigated its correlative pattern with clinical factors (age, gender, race, BMI and smoking history, etc.), HLA, immune signatures, and commensal microbiome.

Introduction In Europe, the SARS‐CoV‐2 pandemic had its first epicenter in Italy. Despite a significant mortality rate, the severity of most cases of COVID‐19 infection ranges from asymptomatic to mildly symptomatic, and silent infection affects a still‐unknown proportion of the general population. No information is available on the prevalence and clinical impact of SARS‐CoV‐2 silent infection among patients with cancer receiving anticancer treatment during the pandemic. Materials and Methods From April 1, 2020, to the end of the same month, 560 consecutive patients with cancer, asymptomatic for COVID‐19 and on anticancer treatment at Papa Giovanni XXIII Hospital in Bergamo, were evaluated and tested for SARS‐CoV‐2. We implemented a two‐step diagnostics, including the rapid serological immunoassay for anti–SARS‐CoV‐2 immunoglobulin (Ig) G/IgM and the nasopharyngeal swab reverse transcriptase‐polymerase chain reaction (RT‐PCR) test in case of seropositivity to identify SARS‐CoV‐2 silent carriers. Results In 560 patients, 172 (31%) resulted positive for anti–SARS‐CoV‐2 IgM/IgG antibodies, regardless of different type of cancer, stage, and treatment. The Ig‐seropositive patients were then tested with RT‐PCR nasopharyngeal swabs, and 38% proved to be SARS‐CoV‐2 silent carriers. At an early follow‐up, in the 97 SARS‐CoV‐2–seropositive/RT‐PCR–negative patients who continued their anticancer therapies, only one developed symptomatic COVID‐19 illness. Conclusion Among patients with cancer, the two‐step diagnostics is feasible and effective for SARS‐CoV‐2 silent carriers detection and might support optimal cancer treatment strategies at both the individual and the population level. The early safety profile of the different anticancer therapies, in patients previously exposed to SARS‐CoV‐2, supports the recommendation to continue the active treatment, at least in cases of RT‐PCR–negative patients. Implications for Practice This is the first study evaluating the prevalence and clinical impact of SARS‐CoV‐2 silent infection in actively treated patients with cancer, during the epidemic peak in one of the worst areas of the COVID‐19 pandemic. Lacking national and international recommendations for the detection of asymptomatic SARS‐CoV‐2 infection, a pragmatic and effective two‐step diagnostics was implemented to ascertain SARS‐CoV‐2 silent carriers. In this series, consisting of consecutive and unselected patients with cancer, the prevalence of both SARS‐CoV‐2–seropositive patients and silent carriers is substantial (31% and 10%, respectively). The early safety profile of the different anticancer therapies, in patients previously exposed to SARS‐CoV‐2, supports the recommendation to continue the active treatment, at least in case of RT‐PCR–negative patients.

Introduction Les populations vulnérables semblent être particulièrement touchées par l’infection à SARS-CoV-2. Pour autant, la caractérisation de l’impact de la pandémie est potentiellement biaisée par les méthodes de surveillances basées sur les données de dépistage en laboratoire et sur le nombre d’hospitalisations du fait de possible difficultés d’accès aux soins de cette population. Cette étude de cohorte a pour objectif d’estimer la prévalence et les facteurs associés à l’infection par le SARS-CoV-2 chez les personnes en situation de sans-abrisme. Matériels et méthodes Les personnes adultes vivant à la rue, en squat/bidonville, hébergement d’urgence, hôtel de mise à l’abri ou centre d’hébergement et de réinsertion sociale de la ville de Marseille ont été invitées à participer à l’étude. Un questionnaire et un test rapide sérologique ont été administrés de juin à début août puis de septembre à décembre 2020. Pour chaque période les résultats incidents des PCR à SARS-CoV-2 étaient également rapportés. Une analyse de survie avec courbe de Kaplan–Meier ainsi qu’un modèle de Cox multivarié a été réalisé afin d’évaluer les facteurs associés à l’infection par le SARS-CoV-2. Résultats Au total, 1249 participants ont été inclus. La séroprévalence était de 6,01 % [4,68–7,34] entre juin et août et de 18,86 % [16,00–21,72] entre septembre et décembre ( p < 0,005). Le fait de vivre dans un centre d’hébergement d’urgence (3,58 [1,08–11,82]) ou un hôtel de mise à l’abri (3,43 [1,04–11,31]) et d’avoir plus de 5 personnes contacts par jour (1,75 [1,23–2,50]) étaient associés dans l’analyse multivariée a un risque plus élevé d’infection. A contrario, la consommation de tabac (0,45 [0,32–0,63]), la difficulté d’accès à des produits d’hygiène (0,64 [0,43–0,96]) et le fait de garder une source de revenue au décours de la crise (0,71 [0,52–0,96]) étaient associées à un risque plus faible. Conclusion Nos résultats confirment l’importance d’adapter les types d’hébergements d’urgence ainsi que la nécessité d’une approche globale auprès des plus vulnérables afin de limiter la diffusion de l’épidémie dans cette population.