Please use this identifier to cite or link to this item:
http://hdl.handle.net/2445/201172
Title: | Pandemic Phase-Adjusted Analysis of COVID-19 Outcomes Reveals Reduced Intrinsic Vulnerability and Substantial Vaccine Protection From Severe Acute Respiratory Syndrome Coronavirus 2 in Patients With Breast Cancer |
Author: | Tagliamento, Marco Gennari, Alessandra Lambertini, Matteo Salazar Soler, Ramón Harbeck, Nadia Mastro, Lucia del Aguilar Company, Juan Bower, Mark Sharkey, Rachel Pria, Alessia dalla Plaja, Andrea Jackson, Amanda Handford, Jasmine Sita-Lumsden, Ailsa Martínez Vila, Clara Matas, Marta Miguel Rodríguez, Ana Vincenzi, Bruno Tonini, Giuseppe Bertuzzi, Alexia Brunet, Joan Pedrazzoli, Paolo Avanzo, Francesca d' Biello, Federica Sinclair, Alasdair Lee, Alvin J.X. Rossi, Sabrina Rizzo, Gianpiero Mirallas, Oriol Pimentel, Isabel Iglesias, María Sanchez de Torre, Ana Guida, Annalisa Berardi, Rossana Zambelli, Alberto Tondini, Carlo Filetti, Marco Mazzoni, Francesca Mukherjee, Uma Diamantis, Nikolaos Parisi, Alessandro Aujayeb, Avinash Prat Aparicio, Aleix Libertini, Michela Grisanti, Salvatore Rossi, Maura Zoratto, Federica Generali, Daniele Saura, Cristina Lyman, Gary H. Kuderer, Nicole M. Pinato, David J. Cortellini, Alessio |
Keywords: | COVID-19 Càncer de mama COVID-19 Breast cancer |
Issue Date: | 31-Jan-2023 |
Publisher: | American Society of Clinical Oncology (ASCO) |
Abstract: | PURPOSE Although representing the majority of newly diagnosed cancers, patients with breast cancer appear less vulnerable to COVID-19 mortality compared with other malignancies. In the absence of patients on active cancer therapy included in vaccination trials, a contemporary real-world evaluation of outcomes during the various pandemic phases, as well as of the impact of vaccination, is needed to better inform clinical practice. METHODS We compared COVID-19 morbidity and mortality among patients with breast cancer across prevaccination (February 27, 2020-November 30, 2020), Alpha-Delta (December 1, 2020-December 14, 2021), and Omicron (December 15, 2021-January 31, 2022) phases using OnCovid registry participants (ClinicalTrials.gov identifier: NCT04393974). Twenty-eight-day case fatality rate (CFR28) and COVID-19 severity were compared in unvaccinated versus double-dosed/boosted patients (vaccinated) with inverse probability of treatment weighting models adjusted for country of origin, age, number of comorbidities, tumor stage, and receipt of systemic anticancer therapy within 1 month of COVID-19 diagnosis. RESULTS By the data lock of February 4, 2022, the registry counted 613 eligible patients with breast cancer: 60.1% (n = 312) hormone receptor-positive, 25.2% (n = 131) human epidermal growth factor receptor 2-positive, and 14.6% (n = 76) triple-negative. The majority (61%; n = 374) had localized/locally advanced disease. Median age was 62 years (interquartile range, 51-74 years). A total of 193 patients (31.5%) presented >= 2 comorbidities and 69% (n = 330) were never smokers. In total, 392 (63.9%), 164 (26.8%), and 57 (9.3%) were diagnosed during the prevaccination, Alpha-Delta, and Omicron phases, respectively. Analysis of CFR28 demonstrates comparable estimates of mortality across the three pandemic phases (13.9%, 12.2%, 5.3%, respectively; P = .182). Nevertheless, a significant improvement in outcome measures of COVID-19 severity across the three pandemic time periods was observed. Importantly, when reported separately, unvaccinated patients from the Alpha-Delta and Omicron phases achieved comparable outcomes to those from the prevaccination phase. Of 566 patients eligible for the vaccination analysis, 72 (12.7%) were fully vaccinated and 494 (87.3%) were unvaccinated. We confirmed with inverse probability of treatment weighting multivariable analysis and following a clustered robust correction for participating center that vaccinated patients achieved improved CFR28 (odds ratio [OR], 0.19; 95% CI, 0.09 to 0.40), hospitalization (OR, 0.28; 95% CI, 0.11 to 0.69), COVID-19 complications (OR, 0.16; 95% CI, 0.06 to 0.45), and reduced requirement of COVID-19-specific therapy (OR, 0.24; 95% CI, 0.09 to 0.63) and oxygen therapy (OR, 0.24; 95% CI, 0.09 to 0.67) compared with unvaccinated controls. CONCLUSION Our findings highlight a consistent reduction of COVID-19 severity in patients with breast cancer during the Omicron outbreak in Europe. We also demonstrate that even in this population, a complete severe acute respiratory syndrome coronavirus 2 vaccination course is a strong determinant of improved morbidity and mortality from COVID-19. |
Note: | Reproducció del document publicat a: https://doi.org/10.1200/JCO.22.01667 |
It is part of: | Journal of Clinical Oncology, 2023, vol. 41, num. 15, p. 2800-2814 |
URI: | http://hdl.handle.net/2445/201172 |
Related resource: | https://doi.org/10.1200/JCO.22.01667 |
ISSN: | 1527-7755 |
Appears in Collections: | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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