Division of Hematology and Oncology, Columbia University Irving Medical Center, and New York Presbyterian Hospital, Herbert Irving Pavilion, New York, NY.
Division of Pathology and Cell Biology, Columbia University Irving Medical Center, and New York Presbyterian Hospital, New York, NY.
Semin Oncol. 2021 Apr;48(2):166-170. doi: 10.1053/j.seminoncol.2020.11.001. Epub 2020 Dec 5.
SARS-CoV-2 (S-2) infection duration and its impact on patients with cancer and mild to moderate COVID-19 undergoing cancer-directed therapy (CDT), especially in the underserved population, is not well described. We conducted a retrospective study to analyze S-2 positive (+) patients on CDT to describe the S-2 duration and its impact on CDT.
Two hundred ninety-nine patients with cancer were tested with nasopharyngeal (NP) S-2 PCR assay at Columbia University Medical Irving Center (CUIMC), a Minority-NCI Community Oncology site, of which 77 (26%) tested positive. We retrospectively analyzed 26 S-2 (+) patients with mild-to-moderate COVID-19 receiving CDT who consented to the study. NP PCR was repeated every 1 to 2 weeks until 2 successive negative (-) PCRs were obtained prior to restarting CDT. Time to 2 (-) PCR and serology results were recorded. Cycling thresholds (Ct) were obtained for S-2 specific targets and represented an indirect measure of viral load.
Demographics of N = 26 patients are: Hispanic (N = 17, 65%), Black (N = 1, 4%), White (N = 7, 27%), and undeclared (N = 1, 4%). Among the tumor histologies represented, gastrointestinal (N = 9, 35%), breast (N = 5, 19%), and sarcoma (N = 3, 12%) were most common. Median time to 2 (-) PCR was 32 days. Twenty patients required greater than 14 days to achieve 2 sequential (-) swabs. CDT was delayed in 21 patients (81%) of whom three experienced disease progression, likely attributed to an interruption in CDT, which was delayed by a mean of 53 days. Interestingly, nine (41%) patients had Ct values greater than 34 for the pan SARS target and seven (32%) patients had Ct values greater than 34 for the SARS-COV-2 target. Sixteen of 16 patients on CDT, tested positive for IgG antibodies at the time of consent, despite protracted viral detectability by NP PCR.
Patients receiving CDT appear to have prolonged detectable S-2 by PCR, which can lead to interruption of CDT and POD in patients. We believe and recommend that patients with asymptomatic to mild COVID-19 and aggressive malignancies are at greatest risk for cancer related morbidity and mortality due to CDT cessation and should be considered for continued CDT without interruption. Ct values and serology testing are tools that can help identify those patients on CDT who may be at greatest risk of worsening COVID-19 or of spreading S-2.
SARS-CoV-2（S-2）感染持续时间及其对接受癌症定向治疗（CDT）的癌症患者和 COVID-19 轻症至中度患者的影响，特别是在服务不足的人群中，尚未得到很好描述。我们进行了一项回顾性研究，以分析接受 CDT 的 S-2 阳性（+）患者，以描述 S-2 持续时间及其对 CDT 的影响。
在哥伦比亚大学欧文医疗中心（CUIMC），即少数民族 NCI 社区肿瘤学站点，对 299 名癌症患者进行了鼻咽（NP）S-2 PCR 检测，其中 77 名（26%）检测呈阳性。我们回顾性分析了 26 名接受 CDT 的轻症至中度 COVID-19 并同意参加研究的 S-2（+）患者。在重新开始 CDT 之前，每 1 到 2 周重复进行 NP PCR，直到连续两次获得阴性（-）PCR 结果。记录获得 2 次（-）PCR 和血清学结果所需的时间。获得了 S-2 特异性靶标的循环阈值（Ct），这是病毒载量的间接衡量标准。
N=26 名患者的人口统计学特征为：西班牙裔（N=17，65%）、黑人（N=1，4%）、白人（N=7，27%）和未申报（N=1，4%）。在所代表的肿瘤组织学中，胃肠道（N=9，35%）、乳房（N=5，19%）和肉瘤（N=3，12%）最为常见。获得 2 次（-）PCR 的中位时间为 32 天。20 名患者需要超过 14 天才能获得 2 次连续（-）拭子。21 名（81%）患者的 CDT 被延迟，其中 3 名患者因 CDT 中断而出现疾病进展，这可能归因于 CDT 延迟，平均延迟 53 天。有趣的是，9 名（41%）患者的泛 SARS 靶标 Ct 值大于 34，7 名（32%）患者的 SARS-COV-2 靶标 Ct 值大于 34。在同意时，接受 CDT 的 16 名患者中的 16 名检测到 IgG 抗体呈阳性，尽管 NP PCR 可检测到病毒持续存在。
接受 CDT 的患者似乎通过 PCR 可检测到的 S-2 持续时间延长，这可能导致 CDT 中断和患者 POD。我们认为并建议，患有无症状至轻度 COVID-19 和侵袭性恶性肿瘤的患者因 CDT 停止而面临最大的癌症相关发病率和死亡率风险，应考虑继续进行 CDT 而不中断。Ct 值和血清学检测是可用于识别那些因 COVID-19 恶化或 S-2 传播而面临最大风险的接受 CDT 患者的工具。
