A study presented this week at the virtual meeting of the European Society for Medical Oncology (ESMO) provided an early look at data that begin to answer those questions. But the answers might not be reassuring. Interim data from the OnCovid trial, a continuing study based at Imperial College London that is tracking COVID-19-related outcomes in people with cancer in the United Kingdom, Spain, and Italy, found that about 1 in 6 patients with cancer who survived COVID-19 developed side effects from the virus that lingered months later. With a median follow-up of four months, half of the patients had long-term respiratory symptoms and about 4 in 10 reported fatigue. About 7 percent had developed neurocognitive problems. Men age 65 and older with two or more comorbidities and a history of smoking were the most likely to develop long COVID-19. People who had been hospitalized for COVID-19 or had complicated COVID-19 were significantly more likely to have long-term effects of COVID-19 than others. The researchers also found that patients with cancer and COVID-19 were nearly twice as likely to die, even after adjusting for sex, age, comorbidities, tumor characteristics, cancer therapy, and COVID-19 severity. Next, the researchers looked at people who were receiving systemic anti-cancer therapy when they were diagnosed with COVID-19. About 13 percent of patients had to stop their cancer treatment permanently. Nearly 16 percent of patients on active treatment had to adjust their cancer treatment due to COVID-19. Immunosuppression was the most common reason cited for altering cancer treatment. About 40 percent of patients who had to adjust their cancer treatment regimens did so to avoid having to be hospitalized, and 1 in 5 did so to avoid the risk of adverse events. These two approaches — stopping treatment or continuing with an altered regimen — had clear implications for people’s long-term outcomes, according to lead author Alessio Cortellini, MD, of the University of L’Aquila in Italy, who spent much of the pandemic as a visiting researcher at Imperial College London. “We found permanent treatment discontinuation to be associated with an increased risk of death, whereas systemic anti-cancer treatment adjustments did not adversely affect survival,” he said. “Therefore, treatment adjustments can be safely pursued to preserve oncological outcomes in patients who remain eligible for treatment.” OnCovid is expected to run until 2022. RELATED: Cancer News Digest: Latest Developments in Cancer Research and Treatment for July

Adding Carboplatin to Chemotherapy Leads to Better Long-Term Outcomes in TNBC

A follow-up study presented at the conference found that women with triple-negative breast cancer (TNBC) who received Paraplatin (carboplatin) plus Taxol (paclitaxel) chemotherapy did better after four-plus years of follow-up than women who had paclitaxel alone. But adding the PARP inhibitor veliparib to carboplatin did not significantly benefit women. The original study, known as the BrighTNess trial and published in The Lancet in April 2018, was a phase III trial that included 634 women from 15 countries. It showed that adding carboplatin to paclitaxel increased the pathologic complete response (pCR) rate by 58 percent versus a pCR rate of 31 percent for women who had paclitaxel alone. (PCR is defined as the complete disappearance of the invasive cancer in the breast and lymph nodes on imaging.) But did those results last long-term? The new study says yes. “It reinforces that adding carboplatin to paclitaxel followed by Adriamycin (doxorubicin) and Cytoxan (cyclophosphamide) improved pathologic complete response significantly,” said lead author Sybille Loibl, MD, PhD, head of the German Breast Group, a leading research group. Women with pCR were also more likely to still be free of recurrence after a median of 4.5 years, which is known as event-free survival. “Importantly, this event-free survival improvement was seen regardless of whether women had a BRCA mutation or not,” Dr. Loibl said. “This means that pCR is a significant prognostic factor for a better long-term outcome.” In the new study, researchers also looked at the regimens’ safety profile, which Loibl called “acceptable,” as well as treatment-related secondary cancers and overall survival. Secondary cancers were rare, occurring in a maximum of 2 percent of women. The BrighTNess trial grew out of concern that women with TNBC face a higher risk of recurrence and worse overall prognosis than those who have other forms of breast cancer. The current standard of care for women with stage 2 and stage 3 TNBC is to receive chemotherapy at diagnosis, followed by surgery to remove the tumor, although other studies have also shown favorable results for adding carboplatin. “Given the consistent results with previous studies, the addition of carboplatin appears to have a favorable risk-to-benefit profile and might be considered as a potential component of neoadjuvant chemotherapy for patients with high-risk, triple-negative breast cancer,” Loibl said.

Women who receive immunotherapy to fight their cancer may be more likely to develop immune-related adverse events than men, according to interim data from another study presented at ESMO this week. “Patients’ sex can influence adaptive immunity and, in turn, the incidence, type, and severity of immune-related adverse events,” said lead author Rosalba Miceli, MD, of the National Cancer Institute of Milan. “We are undertaking a multicenter observational prospective study to investigate immune-related adverse event incidence and female/male inequalities linked to sex (genetic and biological characteristics) and gender (psychosocial and behavioral determinants).” Among 106 patients included in the study to date, the six-month cumulative incidence of grade 2 to higher (moderate to severe) immune-related adverse events in women was more than double that in men (61.4 percent versus 27.9 percent). Patients living alone, particularly men, were at a higher risk of developing moderate to severe immune-related adverse events compared with those who did not live alone. This study is still enrolling participants in Italy, Sweden, Norway, and Ireland. It is expected to be complete in 2023, which will allow researchers to follow study participants for a minimum of 12 months. The study authors plan to use the final trial results to develop tools that could help oncologists better predict which patients might develop immune-related adverse events based on sex.