Study offers global review of impact of COVID-19 on cancer treatment and research
Study represents the most comprehensive scientific survey to date about
the interrelationship between COVID-19 and cancer

Date:
October 6, 2020
Source:
Dana-Farber Cancer Institute
Summary:
A new report suggests that while COVID-19 has complicated the
treatment of cancer patients, it has also spurred creative solutions
to challenges in clinical care, and research into the new disease
is benefiting from insights gained over years of cancer research.



FULL STORY ==========================================================================
The COVID-19 pandemic has impacted virtually every aspect of cancer care
and research- from introducing new risks for cancer patients to disrupting
the delivery of cancer treatment and the continuity of cancer research,
a review of scientific literature shows. The report, by researchers at Dana-Farber Cancer Institute and other institutions, suggests that while COVID-19 has complicated the treatment of cancer patients, it has also
spurred creative solutions to challenges in clinical care, and research
into the new disease is benefiting from insights gained over years of
cancer research.


========================================================================== While much remains to be learned about the intersection of cancer and
COVID-19, the new paper, published online by Cancer Cell, represents the
most comprehensive survey to date about what physicians have learned,
and what research is suggesting, about the interrelationship between
the two diseases, the authors say.

"COVID-19 has been responsible for killing more than one million
people worldwide. Among those most at risk of developing severe forms
of the illness are patients with cancer," says Ziad Bakouny, MD, MSc,
of Dana-Farber, the co- lead author of the study with Jessica Hawley, MD,
of Columbia University Medical Center. "Research into why patients with
cancer are at heightened risk is moving very quickly. In this paper,
we look at the state of the science in this area and others related
to these two illnesses." The paper summarizes findings in four areas:
the interconnected biology of cancer and COVID-19; changes in patient
care prompted by the pandemic; effects on cancer research; and insights
from cancer research applicable to the treatment of COVID-19.

COVID-19 and cancer biology In patients with cancer, COVID-19 can be
especially harsh. This is likely because many patients have a weakened
immune system -- either as a result of the cancer itself or the therapies
used to treat it -- and are therefore less able to fight off infection
by the novel coronavirus. Several studies have examined whether systemic
cancer therapies such as chemotherapy and targeted therapies increase
patients' vulnerability to COVID-19. The results so far are mixed,
Bakouny says, possibly because such studies have focused on systemic
therapies as a group rather than on specific agents. Future studies will attempt to tease out the effects of particular drugs.



==========================================================================
One of the most dangerous consequences of COVID-19 is an overaggressive
immune response known as a "cytokine storm," which can damage lung and
other tissues.

Patients with cancer treated with immune-stimulating therapies such as
immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell
therapies and bi- specific T-cell engagers (BiTEs) are at risk for complications if the immune response produced by these therapies results
in an attack on normal, healthy tissue. Patients treated with CAR T-cell therapies and BiTEs, in particular, can develop a side effect known as
cytokine release syndrome, which is similar to the cytokine storm in
patients with COVID-19. Researchers have theorized that COVID-19 could exacerbate cytokine release syndrome in patients treated with certain immunotherapies, but studies have not definitely shown that this is
happening, the new report states.

Although patients may be understandably concerned about facing an
increased risk from COVID-19 as a result of cancer therapy, they
shouldn't let this deter them from seeking treatment for their cancer,
Bakouny says. "Therapies for cancer can prolong life and even be curative
in many cases," he remarks. "It's very important to be mindful of the
goals of therapy and discuss with your doctor the risks and benefits of
therapy in your own particular case." COVID-19 and cancer care Around
the world, efforts to thwart the spread of COVID-19 included steps to
decrease in-person visits between patients and physicians. Among these
was a jump in the use of telemedicine, which, some studies indicate,
can be just as effective as in-person meetings. One study involving
patients with breast cancer found that telehealth was associated with
a higher quality of life and less depression and distress compared
with usual care. While virtual visits offer a variety of benefits --
less need to travel to physician appointments and incur the costs and inconvenience associated with travel -- they're valuable only insofar
as they don't take the place of in-person visits for exams, treatment,
or diagnosis, research shows.

"It is also important to consider the unintended consequences of
widespread adoption of technology," Bakouny says. "There is a serious
potential risk of compounding health disparities between patients of
different socioeconomic status, if telehealth services are mandated."
On the negative side, studies have shown a sharp decline in cancer
diagnoses and screening during the peak of the pandemic. One study found
that routine screening dropped by 85-90%. Delays in diagnosing cancer
are likely to have long-term ripple effects. A British study estimates
that, because of diagnostic delays, deaths five years from now may be
4-17% higher, depending on tumor type, than they would have been had
the pandemic not occurred.



========================================================================== COVID-19 and cancer research To limit the opportunities for viral
transmission, many research centers enacted policies limiting the number
of lab workers allowed on-site, putting many studies on hold. For
the most part, research projects funded by government appropriations
have not been hobbled by the pandemic, but some projects supported
by private philanthropy face a funding gap. COVID-19 has drastically
decreased donations to cancer-focused philanthropic organizations. The
American Cancer Society, for example, expects a $200 million decrease
in donations this year and has not been able to accept applications for research grants for the Fall grant cycle.

Clinical cancer research, in which potential new therapies are tested in patients, has also experienced difficulties as a result of COVID-19. Some cancer centers halted enrollment on clinical trials entirely during the
height of the pandemic. A survey of dozens of clinical investigators in
March found that nearly 60% of respondents had halted screening and/or enrollment in certain trials, and that half of their institutions had
ceased collection of blood and other tissue for research purposes.

Despite these challenges, investigators found a variety of ways to adapt
to straitened circumstances so trials could continue. These included
leveraging telehealth to limit in-person visits, use of e-signatures
for trial documentation, shipping oral medications to trial participants
rather than requiring them to be picked up at the clinic, and allowing laboratory tests to be done at outside labs.

"The relaxation of some of the regulatory requirements associated with
clinical research has been accomplished without compromising patient
safety," Bakouny remarks. "Many investigators see this as a plus --
something that could be part of clinical research going forward, to
reduce the cost of trials and facilitate the arrival of new therapies for patients." COVID-19 and lessons from cancer Some promising approaches to treating COVID-19 have come, perhaps surprisingly, from cancer research,
the paper's authors write. While cancer and COVID-19 are fundamentally different in their origin, development, and effect on the body, some
of the insights gained in decades of research in cancer are showing
relevance to fighting the new coronavirus.

A variety of drugs used to alleviate cytokine release syndrome in cancer patients are being evaluated for effectiveness against cytokine storm
in patients with COVID-19. Other drugs in the anti-cancer arsenal are undergoing tests of their potential value against COVID-19. An example
is acalabrutinib, which is used in the treatment of lymphoid cancers. In
one trial, it resulted in rapid improvements in oxygen requirements and
a sharp drop in inflammation in patients with COVID-19.

Another potential point of connection between cancer and COVID-19 involves
a protein called TMPRSS2. When the coronavirus is breathed in, it binds
to lung cells and is split by TMPRSS2, allowing it to enter and infect
the cells.

Research has shown that in prostate cancer, TMPRSS2 is regulated by
the androgen receptor, a cell structure that signals the cell to grow
in response to androgen. The androgen receptor is found not only on
prostate cells but on cells of the lung as well. It isn't clear yet
whether the receptor regulates TMPRSS2 in lung tissue, but if it does,
it could open the way to a new treatment for COVID-19. Androgen-targeting therapies already used to treat prostate cancer could block TMPRSS2 from entering lung cells, preventing COVID- 19 at its source.

"Since the start of the pandemic, we've accumulated a substantial amount
of evidence about the dynamic between cancer and COVID-19," Bakouny
remarks. "This review gave us an opportunity to take a step back and
take stock of what we've learned -- to get a sense of the most promising directions for patients, as well as where more study is needed, what
we need to dig deeper into." The senior author of the study is Corrie
Painter, PhD, of the Broad Institute of MIT and Harvard. Co-authors
are Toni Choueiri, MD, of Dana-Farber; Solange Peters, MD, PhD, of the
Centre Hospitalier Universitaire Vaudois, in Lausanne, Switzerland;
and Brian Rini, MD, and Jeremy Warner, MD, MS, of Vanderbilt University
Medical Center.

The research was partly funded by VUMC CCSG grant P30 CA068485.


========================================================================== Story Source: Materials provided by Dana-Farber_Cancer_Institute. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Ziad Bakouny, Jessica E. Hawley, Toni K. Choueiri, Solange Peters,
Brian
I. Rini, Jeremy L. Warner, Corrie A. Painter. COVID-19 and Cancer:
Current Challenges and Perspectives. Cancer Cell, 2020; DOI:
10.1016/ j.ccell.2020.09.018 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201006153524.htm

--- up 6 weeks, 1 day, 6 hours, 50 minutes
* Origin: -=> Castle Rock BBS <=- Now Husky HPT Powered! (1337:3/111)