COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

Abstract

Background: Cancer patients have been reported to be at higher risk of COVID-19 complications and deaths. We report the characteristics and outcome of patients diagnosed with COVID-19 during breast cancer treatment at Institut Curie hospitals (ICH, Paris area, France).Methods: An IRB-approved prospective registry was set up at ICH on March 13 th , 2020 for all breast cancer patients with COVID-19 symptoms or radiologic signs. Registered data included patient history, tumor characteristics and treatments, COVID-19 symptoms, radiological features and outcome. Data extraction was done on April 25 th , 2020. COVID-19 patients were defined as those with either a positive RNA test or typical, newly appeared lung CT-scan abnormalities.Results: Among 15,600 patients actively treated for early or metastatic breast cancer during the last 4 months at ICH, 76 patients with suspected COVID-19 infection were included in the registry and followed.Fifty-nine of these patients were diagnosed with COVID-19 based on viral RNA testing (N=41) or typical radiologic signs: 37/59 (63%) COVID-19 patients were treated for metastatic breast cancer, and 13/59 (22%) of them were taking corticosteroids daily. Common clinical features mostly consisted of fever and/or cough, while ground-glass opacities were the most common radiologic sign at diagnosis. We found no association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. Twenty-eight of these 59 patients (47%) were hospitalized and 6 (10%) were transferred to an intensive care unit. At the time of analysis, 45/59 (76%) patients were recovering or had been cured, 10/59 (17%) were still followed and 4/59 (7%) had died from COVID-19. All 4 patients who died had significant non-cancer comorbidities. In univariate analysis, hypertension and age (>70) were the two factors associated with a higher risk of intensive care unit admission and/or death. Conclusions:This prospective registry analysis suggests that the COVID-19 mortality rate in breast cancer patients depends more on comorbidities than prior radiation therapy or current anti-cancer treatment. Special attention must be paid to comorbidities when estimating the risk of severe COVID-19 in breast cancer patients.All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

Chemotherapy Increases the Risk of Developing Severe Illness in Breast Cancer Patients with COVID-19: A Multi-Center Retrospective Study in Hubei, China

“…Noteworthy, in Vuagnat's study, univariate analysis showed that the ongoing cancer therapy (within 30 days) was not associated with disease severity, and there were no further analysis into cancer therapy within 7 or 14 days. Besides, the number of patient events in their study was too small to have multivariate analysis [14]. In addition, our study demonstrated the age over 75 as a distinct risk factor of severity, which shared a similar results with Vuagnat's report (age over 70).…”

“…Remarkably, breast cancer patients with COVID-19 had lower disease severity and mortality when compared with general cancer patients. Compared with the similar works of breast cancer patients with COVID-19 in the world, the mortality in our study was 6.7%, which is similar to that in Vuagnat's study(6.7%) and higher than Kalinsky's study(3.7%) [14,18]. These different outcomes among breast cancer patients could be explain by the different regional distribution and availability of medical cure, testing methods, subtypes and virulence of SARS-CoV-2.…”

“…Their mortality rate was 14%, far below the average of general cancer patients (28%) [5,9]. A study from Paris suggested that the severity of breast cancer patients with COVID-19 resided more in comorbidities [14]. However, our previous study found that cancer patients with anti-cancer treatment had a poorer prognosis, which prompted us to nd the relationship between disease severity and anti-cancer treatment among breast cancer population.…”

Association of active oncologic treatment and risk of death in cancer patients with COVID-19: a systematic review and meta-analysis of patient data

“…Following initial database search and screening, twenty-eight full-text articles were assessed for eligibility. Among these studies, twelve studies were excluded because individual patient data required for calculation of case fatalities in our study-specified treatment modality groups were not reported [8][9][10][11][12][13][14][15][16][17][18]. Among these studies, because of overlapping data of four patients with Garassino et al, Stroppa et al was excluded from the analysis [19].…”

Evidence-based management of COVID-19 in cancer patients: Guideline by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

“…Routine delay or discontinuation of antineoplastic therapy in patients without suspected/confirmed SARS-CoV-2 infection is not recommended even in times of pandemic (DII u ). 18 , 20 , 31 , 33 , 40 , 92 , 93 , 94 In case of suspected SARS-CoV-2 infection, e.g. due to contact with a confirmed case or a high incidence in the area, we strongly recommend to quarantine the patient and delay antineoplastic therapy for up to 14 days, if not detrimental for cancer prognosis (AIII).…”