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Clinical portrait of the SARS-CoV-2 epidemic in European cancer patients

Pinato et al., Cancer Discovery, doi:10.1158/2159-8290.CD-20-0773
Aug 2020  
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Mortality 59% Improvement Relative Risk HCQ for COVID-19  Pinato et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 890 patients in multiple countries Lower mortality with HCQ (p=0.0001) c19hcq.org Pinato et al., Cancer Discovery, August 2020 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020, now with p < 0.00000000001 from 419 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 109 treatments. c19hcq.org
Retrospective 890 cancer patients with COVID-19, adjusted mortality HR for HCQ/CQ 0.41, p<0.0001. Confirmed SARS-CoV-2 infection was required, which may help focus on more severe cases. Analysis with Cox proportional hazard model. Potential unmeasured confounders.
risk of death, 59.0% lower, HR 0.41, p < 0.001, treatment 30 of 182 (16.5%), control 181 of 446 (40.6%), NNT 4.1.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Pinato et al., 18 Aug 2020, retrospective, multiple countries, peer-reviewed, 72 authors.
This PaperHCQAll
Clinical Portrait of the SARS-CoV-2 Epidemic in European Patients with Cancer
David J Pinato, Alberto Zambelli, Juan Aguilar-Company, Mark Bower, Christopher C T Sng, Ramon Salazar, Alexia Bertuzzi, Joan Brunet, Ricard Mesia, Elia Seguí, Federica Biello, Daniele Generali, Salvatore Grisanti, Gianpiero Rizzo, Michela Libertini, Antonio Maconi, Nadia Harbeck, Bruno Vincenzi, Rossella Bertulli, Diego Ottaviani, Anna Carbó, Riccardo Bruna, Sarah Benafif, Andrea Marrari, Rachel Wuerstlein, M Carmen Carmona-Garcia, Neha Chopra, Carlo Tondini, Oriol Mirallas, Valeria Tovazzi, Marta Betti, Salvatore Provenzano, Vittoria Fotia, Claudia Andrea Cruz, Alessia Dalla Pria, Francesca D'avanzo, Joanne S Evans, Nadia Saoudi-Gonzalez, Eudald Felip, Myria Galazi, Isabel Garcia-Fructuoso, Alvin J X Lee, Thomas Newsom-Davis, Andrea Patriarca, David García-Illescas, Roxana Reyes, Palma Dileo, Rachel Sharkey, Yien Ning Sophia Wong, Daniela Ferrante, Javier Marco-Hernández, Anna Sureda, Clara Maluquer, Isabel Ruiz-Camps, Gianluca Gaidano, Lorenza Rimassa, Lorenzo Chiudinelli, Macarena Izuzquiza, Alba Cabirta, Michela Franchi, Armando Santoro, Aleix Prat, Josep Tabernero, Alessandra Gennari, Gian Carlo Avanzi, Mattia Bellan, Luigi Mario Castello, Maria Martinez, Meritxell Mollà, Mario Pirisi, Lorenza Scotti, Judith Swallow
Cancer Discovery, doi:10.1158/2159-8290.cd-20-0773
The SARS-CoV-2 pandemic signifi cantly affected oncology practice across the globe. There is uncertainty as to the contribution of patients' demographics and oncologic features to severity and mortality from COVID-19 and little guidance as to the role of anticancer and anti-COVID-19 therapy in this population. In a multicenter study of 890 patients with cancer with confi rmed COVID-19, we demonstrated a worsening gradient of mortality from breast cancer to hematologic malignancies and showed that male gender, older age, and number of comorbidities identify a subset of patients with signifi cantly worse mortality rates from COVID-19. Provision of chemotherapy, targeted therapy, or immunotherapy did not worsen mortality. Exposure to antimalarials was associated with improved mortality rates independent of baseline prognostic factors. This study highlights the clinical utility of demographic factors for individualized risk stratifi cation of patients and supports further research into emerging anti-COVID-19 therapeutics in SARS-CoV-2-infected patients with cancer. SIGNIFICANCE: In this observational study of 890 patients with cancer diagnosed with SARS-CoV-2, mortality was 33.6% and predicted by male gender, age ≥65, and comorbidity burden. Delivery of cancer therapy was not detrimental to severity or mortality from COVID-19. These patients should be the focus of shielding efforts during the SARS-CoV-2 pandemic. Cancer Research.
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Carmen', 'family': 'Carmona-Garcia', 'sequence': 'additional', 'affiliation': [ { 'name': '9Department of Medical Oncology, Catalan Institute of Oncology, ' 'University Hospital Josep Trueta, Girona, Spain.'}]}, { 'given': 'Neha', 'family': 'Chopra', 'sequence': 'additional', 'affiliation': [ { 'name': '6Cancer Division, University College London Hospitals, London, ' 'United Kingdom.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-0635-8954', 'authenticated-orcid': False, 'given': 'Carlo', 'family': 'Tondini', 'sequence': 'additional', 'affiliation': [{'name': '2Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-8492-5195', 'authenticated-orcid': False, 'given': 'Oriol', 'family': 'Mirallas', 'sequence': 'additional', 'affiliation': [ { 'name': "3Medical Oncology, Vall d'Hebron University Hospital and " 'Institute of Oncology (VHIO), Barcelona, Spain.'}]}, { 'given': 'Valeria', 'family': 'Tovazzi', 'sequence': 'additional', 'affiliation': [{'name': '15Medical Oncology Unit, Spedali Civili, Brescia, Italy.'}]}, { 'given': 'Marta', 'family': 'Betti', 'sequence': 'additional', 'affiliation': [ { 'name': '18Infrastruttura Ricerca Formazione Innovazione, Azienda ' 'Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, ' 'Italy.'}]}, { 'given': 'Salvatore', 'family': 'Provenzano', 'sequence': 'additional', 'affiliation': [{'name': '21Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.'}]}, { 'given': 'Vittoria', 'family': 'Fotia', 'sequence': 'additional', 'affiliation': [{'name': '2Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.'}]}, { 'given': 'Claudia Andrea', 'family': 'Cruz', 'sequence': 'additional', 'affiliation': [ { 'name': '11Department of Medical Oncology, Hospital Clinic, Barcelona, ' 'Spain.'}]}, { 'given': 'Alessia', 'family': 'Dalla Pria', 'sequence': 'additional', 'affiliation': [ { 'name': '5Department of Oncology and National Centre for HIV Malignancy, ' 'Chelsea and Westminster Hospital, London, United Kingdom.'}]}, { 'given': 'Francesca', 'family': "D'Avanzo", 'sequence': 'additional', 'affiliation': [ { 'name': '12Division of Oncology, Department of Translational Medicine, ' "University of Piemonte Orientale and Maggiore della Carita' " 'Hospital, Novara, Italy.'}]}, { 'given': 'Joanne S.', 'family': 'Evans', 'sequence': 'additional', 'affiliation': [ { 'name': '1Department of Surgery and Cancer, Imperial College London, ' 'Hammersmith Hospital, London, United Kingdom.'}]}, { 'given': 'Nadia', 'family': 'Saoudi-Gonzalez', 'sequence': 'additional', 'affiliation': [ { 'name': "3Medical Oncology, Vall d'Hebron University Hospital and " 'Institute of Oncology (VHIO), Barcelona, Spain.'}]}, { 'given': 'Eudald', 'family': 'Felip', 'sequence': 'additional', 'affiliation': [ { 'name': '10Department of Medical Oncology, Catalan Institute of Oncology, ' 'Badalona, Spain.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-1933-2414', 'authenticated-orcid': False, 'given': 'Myria', 'family': 'Galazi', 'sequence': 'additional', 'affiliation': [ { 'name': '6Cancer Division, University College London Hospitals, London, ' 'United Kingdom.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-7417-4703', 'authenticated-orcid': False, 'given': 'Isabel', 'family': 'Garcia-Fructuoso', 'sequence': 'additional', 'affiliation': [ { 'name': '9Department of Medical Oncology, Catalan Institute of Oncology, ' 'University Hospital Josep Trueta, Girona, Spain.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-7427-9142', 'authenticated-orcid': False, 'given': 'Alvin J.X.', 'family': 'Lee', 'sequence': 'additional', 'affiliation': [ { 'name': '6Cancer Division, University College London Hospitals, London, ' 'United Kingdom.'}]}, { 'given': 'Thomas', 'family': 'Newsom-Davis', 'sequence': 'additional', 'affiliation': [ { 'name': '5Department of Oncology and National Centre for HIV Malignancy, ' 'Chelsea and Westminster Hospital, London, United Kingdom.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-4415-2906', 'authenticated-orcid': False, 'given': 'Andrea', 'family': 'Patriarca', 'sequence': 'additional', 'affiliation': [ { 'name': '22Division of Haematology, Department of Translational Medicine, ' "University of Piemonte Orientale and Maggiore della Carita' " 'Hospital, Novara, Italy.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-3129-653X', 'authenticated-orcid': False, 'given': 'David', 'family': 'García-Illescas', 'sequence': 'additional', 'affiliation': [ { 'name': "3Medical Oncology, Vall d'Hebron University Hospital and " 'Institute of Oncology (VHIO), Barcelona, Spain.'}]}, { 'given': 'Roxana', 'family': 'Reyes', 'sequence': 'additional', 'affiliation': [ { 'name': '11Department of Medical Oncology, Hospital Clinic, Barcelona, ' 'Spain.'}]}, { 'given': 'Palma', 'family': 'Dileo', 'sequence': 'additional', 'affiliation': [ { 'name': '6Cancer Division, University College London Hospitals, London, ' 'United Kingdom.'}]}, { 'given': 'Rachel', 'family': 'Sharkey', 'sequence': 'additional', 'affiliation': [ { 'name': '5Department of Oncology and National Centre for HIV Malignancy, ' 'Chelsea and Westminster Hospital, London, United Kingdom.'}]}, { 'given': 'Yien Ning Sophia', 'family': 'Wong', 'sequence': 'additional', 'affiliation': [ { 'name': '6Cancer Division, University College London Hospitals, London, ' 'United Kingdom.'}]}, { 'given': 'Daniela', 'family': 'Ferrante', 'sequence': 'additional', 'affiliation': [ { 'name': '23Department of Translational Medicine, Unit of Medical ' 'Statistics, University of Piemonte Orientale and Cancer ' 'Epidemiology, CPO Piemonte, Novara, Italy.'}]}, { 'given': 'Javier', 'family': 'Marco-Hernández', 'sequence': 'additional', 'affiliation': [ { 'name': '24Department of Internal Medicine, Hospital Clinic, Barcelona, ' 'Spain.'}]}, { 'given': 'Anna', 'family': 'Sureda', 'sequence': 'additional', 'affiliation': [ { 'name': '25Haematology Department, ICO Hospitalet, Hospitalet de ' 'Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, ' 'Spain.'}]}, { 'given': 'Clara', 'family': 'Maluquer', 'sequence': 'additional', 'affiliation': [ { 'name': '25Haematology Department, ICO Hospitalet, Hospitalet de ' 'Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, ' 'Spain.'}]}, { 'ORCID': 'http://orcid.org/0000-0003-3743-2379', 'authenticated-orcid': False, 'given': 'Isabel', 'family': 'Ruiz-Camps', 'sequence': 'additional', 'affiliation': [ { 'name': "4Infectious Diseases, Vall d'Hebron University Hospital, " 'Barcelona, Spain.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-4681-0151', 'authenticated-orcid': False, 'given': 'Gianluca', 'family': 'Gaidano', 'sequence': 'additional', 'affiliation': [ { 'name': '22Division of Haematology, Department of Translational Medicine, ' "University of Piemonte Orientale and Maggiore della Carita' " 'Hospital, Novara, Italy.'}]}, { 'ORCID': 'http://orcid.org/0000-0001-9957-3615', 'authenticated-orcid': False, 'given': 'Lorenza', 'family': 'Rimassa', 'sequence': 'additional', 'affiliation': [ { 'name': '8Medical Oncology and Hematology Unit, Humanitas Cancer Center, ' 'Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, ' 'Italy.'}, { 'name': '26Department of Biomedical Sciences, Humanitas University, Pieve ' 'Emanuele, Milan, Italy.'}]}, { 'ORCID': 'http://orcid.org/0000-0002-5903-1843', 'authenticated-orcid': False, 'given': 'Lorenzo', 'family': 'Chiudinelli', 'sequence': 'additional', 'affiliation': [{'name': '2Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.'}]}, { 'given': 'Macarena', 'family': 'Izuzquiza', 'sequence': 'additional', 'affiliation': [ { 'name': "27Department of Haematology, Vall d'Hebron University Hospital " 'and Institute of Oncology (VHIO), Barcelona, Spain.'}]}, { 'ORCID': 'http://orcid.org/0000-0001-7198-8894', 'authenticated-orcid': False, 'given': 'Alba', 'family': 'Cabirta', 'sequence': 'additional', 'affiliation': [ { 'name': "27Department of Haematology, Vall d'Hebron University Hospital " 'and Institute of Oncology (VHIO), Barcelona, Spain.'}]}, { 'given': 'Michela', 'family': 'Franchi', 'sequence': 'additional', 'affiliation': [{'name': '2Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.'}]}, { 'given': 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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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