COVID-19 - Coronavirus disease 2019

Prospective analysis of morbi-mortality of patients with cancers in active phase of medical treatment suspected or diagnosed of a SARS-COV2 infection. – ONCOVID-19

Submission summary

Since December 2019, the novel coronavirus (SRAS-COV2, causing an emerging infectious disease called COVID-19) has spread quickly worldwide. As of Mar 16th 2020, 165 000 cases and 6 500 deaths have been reported over 146 countries (WHO data). In Europe, Italy, Spain, France and Germany are currently the countries with most reported cases and deaths (mortality ranges from 1.4% to 3.6% of cases confirmed).
The main symptoms of COVID-19 include febrile respiratory infection, respiratory difficulties and, in most severe cases, acute respiratory distress, acute renal insufficiency or multi-visceral deficiency leading to death. To date, epidemiological studies have not focused on specific subgroups despite mortality seems to be much higher in frail persons. During similar previous epidemics (eg A(H1N1)pdm09) different from seasonal influenza, more severe respiratory disease and higher specific mortality were reported, especially in patients with cancer or immunosuppressed populations. Pneumonia has been reported more frequently in patients with hematologic malignancies than those with solid tumors (55% vs 25%) and the 30-day mortality is higher in patients with pneumonia (up to 26%).
For COVID-19, lethal cases are mostly patients >60 (80%) with associated conditions such as cardiovascular problem, diabetes or cancer. In recent reports, an over representation of patients with cancer active treatment or cancer in remission was observed in patients with COVID-19.
While all efforts are now being conducted to prevent the epidemic spread in our country, it is likely that more cases will be diagnosed in the coming months. The population of patients with cancers in active treatment (cytotoxics, immunotherapy, targeted therapy) was estimated to be close to 250 000 yearly in France (0.37% of the French population) [e-cancer.fr].
This is a large population of French citizens, who will be potentially affected with COVID-19, and represents a population at risk of life-threatening complications.
In this context, blood parameters are closely followed up in patients with cancer as there is a straight relationship with treatment toxicity and patients’ outcomes. For cytotoxic chemotherapy, febrile neutropenia is observed in 5-90% of patients depending on the regimen used. Lymphopenia is frequently observed in patients with cancer and early lymphopenia correlates with the risk of febrile neutropenia and early death. Febrile neutropenia is a frequent and life-threatening complication, often associated with respiratory tract infection, which confers severity and a need for hospitalization. In onco-hematology, hypogammaglobulinemia is well-known to reduce immune function. Patients with decreased levels of gamma globulins have lower antibody counts, and an increased risk of infection.
We hypothesize that patients under active anti-cancer treatment are at higher risk to develop severe complications. It is likely that this risk is different from the type of treatment and it is necessary to assess the differential impact.
We propose a national collaborative study to describe retrospectively and prospectively the clinical outcome of patients with a suspected coronavirus infection (either confirmed or not) while receiving a medical anticancer treatment, including corticotherapy. Patients under anticancer treatment who have underwent a diagnostic test for the COVID-19 will be included. The 2-month mortality will be described in both groups (positive and negative cases) to assess the over-risk of mortality, adjusted on main clinical characteristics, the treatment and the type of cancer. Secondary objectives will be to describe the patients’ characteristics, the associated complications, the hospitalizations and to identify predictive factors for mortality. All patients (positive and negative) will be included from all the French Comprehensive Anticancer Centers (UNICANCER), retrospectively (from Jan 1st 2020) and prospectively a soon as the study is activated.

Project coordination

David Pérol (CRLCC de LYON - CENTRE LEON BERARD)

The author of this summary is the project coordinator, who is responsible for the content of this summary. The ANR declines any responsibility as for its contents.

Partner

Unicancer
CLB Centre Léon Bérard
CLB CRLCC de LYON - CENTRE LEON BERARD

Help of the ANR 30,000 euros
Beginning and duration of the scientific project: March 2020 - 12 Months

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