A global review of COVID-19 impact on cancer treatment and research

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trader32176
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A global review of COVID-19 impact on cancer treatment and research

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A global review of COVID-19 impact on cancer treatment and research

10/7/20


https://www.news-medical.net/news/20201 ... earch.aspx


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."

-Ziad Bakouny, MD, MSc, Dana-Farber Cancer Institute

Bakouny is also 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."
trader32176
Posts: 906
Joined: Fri Jun 26, 2020 5:22 am

Re: A global review of COVID-19 impact on cancer treatment and research

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Cancer research another long-term casualty of the coronavirus pandemic, scientists say
The pandemic has caused unprecedented disruptions in cancer research.

10/21/20


https://www.nbcnews.com/health/health-n ... y-n1243878


As the death toll from the coronavirus climbs, Karen Hilton, of Dalkeith, Scotland, sees herself and others fighting cancer as “collateral damage.”

Hilton, 48, was diagnosed with an aggressive form of breast cancer four years ago. After a double mastectomy, surgeries to remove her ovaries and fallopian tubes that were also at risk of cancer due to a BRCA1 gene mutation, and many rounds of chemotherapy, Hilton said her treatment options are dwindling.

In March, she received a prognosis of six to 12 months. Still receiving chemo, she wasn’t looking to enroll in a trial at the height of the pandemic. But as lockdowns return, she fears another disruption could ruin her chance to enroll in clinical trials which might help prolong her life.

“We feel like we’ve been robbed of our life twice,” she told NBC News by phone.

The pandemic has caused unprecedented disruptions in medical research for potentially lifesaving cancer treatments. Research projects have been delayed, scientists have had to renegotiate funding deals and cancer charities face huge economic challenges. Even as some trials have returned to normal, experts warn cancer research will be a long-term casualty of the virus.

Cancer trials are not easy to get in during the best of times because candidates have to meet specific criteria, oncologist Dr. Olga Oikonomidou of the Cancer Research U.K. Edinburgh Center, University of Edinburgh said. Experimental treatments provide no guarantees for longevity or a cure and can even cause more adverse reactions.

“But it is a hope and it is an additional option,” Oikonomidou, who is Hilton's doctor, said.

While doctors do everything they can to get patients into appropriate trials, additional restrictions on travel or other factors related to the pandemic make the fears of patients like Hilton valid, she added.

Having just been married in the summer — the ceremony which was also rescheduled three times because of the pandemic — and with a teenage son at home, Hilton said any more time she can have with her family counts.

“It does make you feel you've been sidelined,” she said. “We need to work alongside all these diseases and they need to be getting the same priority.”

Cancer is the second-leading cause of death worldwide, claiming an estimated 9.6 million lives in 2018, according to the International Agency for Research on Cancer.

While treatment of the disease has improved in high income countries like Britain, experts say there is still much to learn.

In March, when Europe and the United States were being slammed by the pandemic, a study out of the Cancer Research Institute in New York found only about 14 percent of clinical trials by institutions were recruiting new patients at regular levels. At least 200 interventional oncology trials listed in the U.S. National Institutes of Health global database were suspended between mid-March and early April, the study found.

The lead author of the study, Samik Upadhaya, said patients already enrolled were also affected.

“Nearly 60 percent of the investigators we surveyed reported that the pandemic had a moderate or a high impact in delaying or canceling patient visits to these trials,” he said. “There's a significant disruption in terms of collecting crucial patient data.”

It will be very difficult to measure the impact these disruptions will have on the advancement of medicine and on the lives of patients in the months and years ahead, Ian Walker, director of research for the charity Cancer Research U.K., said.

But the effects will be “significant” and “will undoubtedly set us back,” he said.

David Cameron, a professor of medical oncology specializing in breast cancer at the University of Edinburgh, experienced the issue first hand with a European study that was forced to pause recruitment for about six months once the lockdown came into effect in March.

The study, called Aurora, aims to help provide better treatments for metastatic breast cancer. It involves tests on patients that require a collaboration of hospital departments and the university — which were either overwhelmed by coronavirus patients or simply shut down, he said.

“It's not just the question of the oncology department being involved,” Cameron said “The complexity of modern trials means that actually you need all of the system to be functioning.”

Many physicians and medical staff in the U.K., as in other countries, were reassigned to help with front-line care during the peak of the pandemic or were diverted to researching the coronavirus, David Sebag-Montefiore, a clinical director at the Leeds Cancer Research Center, said.

“We had to react, in reality, to an unprecedented set of circumstances,” Sebag-Montefiore said. “Obviously, due to the huge emergency of Covid, that was critically important to do.”

Above all, the risk of exposing vulnerable cancer patients to the coronavirus during visits to health facilities had to be considered, he added. That calculation allowed for his trials for bowel cancer treatment to continue.

“We needed to assess … where the balance of safety versus risk was in favor of the treatment,” he said. “It's very clear that not being able to cure this cancer can actually have very, very severe consequences for patients.”

Similarly, Cameron said, one of his breast cancer trials was able to continue despite the pandemic. It was just a matter of adapting practices to the restrictions of the virus.

“Let's be creative, without changing the quality of what we do,” he said, pointing to the example of the adoption of telemedicine for consultations that were previously done in person.

At the University of Edinburgh, Carsten Hansen works with a team of researchers in a lab to identify variations of mesothelioma — a cancer in the lungs caused by asbestos exposure that can kill patients within a year of diagnosis — in order to develop targeted treatment.

But in mid-March, when the country was forced to lock down, Hansen and his team scrambled to preserve what they could and packed up any work that could be done from outside the lab.

“Laboratory-based research were not deemed essential workers,” he said, adding the approach wasn’t universal and some countries such as South Korea and Japan allowed research to continue.

Even though he’s been back in the lab since mid-July, Hansen said, his team is having to work in a rotation since social distancing only allows facilities to operate up to 50 percent capacity.

“It's clearly a huge challenge,” he said of the impact on collaboration and teaching in the lab. “That, of course, also has an impact on how we can take the project forward.”

The project was due to end in 2022. But the various delays caused by the pandemic have meant Hansen had to go back to the charities funding the work to ask for flexible payments so it can be extended — which he feels fortunate to have been approved.

Research funding more broadly, however, is looking less certain as medical charities cancel fundraisers and the economic toll leads to fewer donations.

In the U.K., cancer charities — which fund over half of publicly-run cancer research — are anticipated to see a $216 million drop in contributions available for research over the next year, the National Cancer Research Institute has said. The American Cancer Society has issued an appeal for donations.

“This will undoubtedly delay discovery of new therapies, and it will undoubtedly, have had a really significant impact on cancer patients,” Walker from Cancer Research U.K. said.

Already, for every two deaths due to the coronavirus in the United States, another person has died because of the ranging impact the pandemic has had on health care, according to a recent study in the Journal of the American Medical Association.

The study’s author, Dr. Steven Woolf, said he anticipates such deaths resulting from disrupted medical testing and treatment will continue for years to come.

Cameron agreed, adding that public funds from increasingly cash-strapped governments needs to be upheld, since many advancements in treatments haven’t exclusively come from the commercial sector.

“There is clearly still a lot of work to do, and lots of insights we've yet to find out and yet to discover,” he said.

But whether different sectors band together and put forward the necessary funding for that research in the post-pandemic world is a question that lingers among patients like Hilton.

“If the whole world jumps because of Covid, then can't they do the same for cancer and stop it being such a debilitating disease?” Hilton said.
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