COVID-19 and Cancer: Current Challenges and Perspectives - Ziad Bakouny, Jessica Hawley, and Corrie A. Painter
October 23, 2020
Ziad Bakouny, MD, MSc is a post-doctoral research fellow at the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute
Jessica E. Hawley, MD, Division of Hematology and Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
Corrie Painter, Ph.D. Associate Director of Operations and Scientific Outreach for the Broad Cancer Program, Broad Institute of MIT and Harvard, Associate Director of Count Me In
Alicia Morgans, MD, MPH, Associate Professor of Medicine in the Division of Hematology/Oncology at the Northwestern University Feinberg School of Medicine in Chicago, Illinois.
COVID-19 and Cancer: Current Challenges and Perspectives
The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care - Re-envisioning the Future - Zachary Klaassen and Christopher J.D. Wallis
The OncCOVID App – Assessing the Risk of a Cancer Patient Contracting COVID-19 vs Delaying Diagnosis or Treatment - Daniel Spratt
ASCO 2020: Looking Back on COVID-19 in Order to Move Forward
Alicia Morgans: Hi, my name is Alicia Morgans, GU medical oncologist and associate professor of medicine at Northwestern University. I'm so excited to have here with me today, a team that has come together through the CCC19 group to write a paper that is really a comprehensive review of COVID-19 and cancer, really reflecting on current challenges and perspectives. We have three authors here with us today to discuss this paper. Please introduce yourselves, and we'll go from here.
Corrie Painter: Hi everybody. Thanks so much for having us here today. My name is Corrie Painter. I'm the Deputy Director of the program called Count Me In at the Broad Institute of MIT and Harvard and I'm also a steering committee member for the CCC19 consortium.
Jessica Hawley: Hi, thanks so much, Alicia. My name is Jessica Hawley, and I'm an Assistant Professor of Medicine at Columbia University in New York and a brand new GU oncologist to the group. Thanks for having me.
Ziad Bakouny: Hi Alicia. Thank you. I'm Ziad Bakouny. I'm a research fellow at the Dana Farber Cancer Institute, and I'm currently working on GU oncology and the intersection of COVID and cancer and I work with Toni Choueiri and Eli Van Allen.
Alicia Morgans: Wonderful. Well, we certainly appreciate your time today, guys, and your review of this work, which again has come out of findings and thoughts around the CCC19 consortium of cancer and COVID-19, so I'm wondering, Corrie, can you start by just telling us why we needed to have this comprehensive review in the first place?
Corrie Painter: Yes, thanks for asking. We live in an unprecedented time right now in the pandemic as everybody is well aware and the amount of information that has been generated is tremendous. And if you want to understand where we are with respect to the effect of COVID on patients that have cancer, there really wasn't a comprehensive review before and so we came together in order to take a look at what has been published. The sheer volume of what's been published just within the last eight months is phenomenal. So both, what has been peer-reviewed, as well as everything that is in a pre-print form, has built this body of knowledge that we decided that we would write this paper on.
Alicia Morgans: Wonderful and I agree with you. I think that there has been so much data, so many papers, some retractions, just so much for us to really sort through. It's been, I think, really helpful to have this review come out, and I should emphasize that it is available for download at this point from Cancer Cell. It is not yet published per se, but it is available for download so that everyone who is listening can read it. And, Jessica, can you tell us a little bit about what CCC19 is and how you and the team came together to pull together this review?
Jessica Hawley: Sure, of course. So CCC19 stands for COVID-19 and Cancer Consortium, and it is a grassroots organization that was born out of an idea on Twitter actually by a young, at the time, a young oncology fellow, I believe he was at the Mayo Clinic at the time or is now, and his name is Aakash Desai and it started when the pandemic was starting back in March and there is now over 100 participating academic and community-based oncology programs that are contributing cases to better inform more of a collective understanding of how COVID-19 is affecting our patients with cancer and there are various institutions involved.
But the primary, the principal investigator is a man named Jeremy Warner who is based in Vanderbilt and under the guidance of a steering committee is rapidly evaluating all of the data, all of the cases that have been contributed by the various centers and publishing our findings with the intention of that we can learn more about taking care of our patients with COVID and cancer together then we can individually at each of our distinct centers. So for me, getting involved, really helping Columbia become involved, was really more of an altruistic motive to be a good citizen, and to bring all of our information to the greater collective understanding.
Alicia Morgans: I think that is so important because as we think about how we normally do research in cancer care, it can be benchtop research, it can be that preclinical work that goes into understanding mechanisms and the biology. It can be therapeutic research, first-in-human, and to clinical trials, it can be epidemiologic, but what we need in the midst of a pandemic with a completely new entity that is affecting our patients is to come together in this way. This collective collection of data and understanding the outcomes that our patients face is the only way to find out what we really need to know, which is how our patients are affected and how do we best care for them. So the CCC19 group that has pulled together, as you said, over 100 institutions and thousands, and thousands of patients and their follow-up data is such a powerful organization and a powerful collection of data for us to understand things. And Ziad, can you tell us a little bit about what are some of the main points made in this comprehensive review?
Ziad Bakouny: Yeah, of course, and thank you for asking. So what we tried to do in this review is really to go from the biological underpinnings of the relationship between COVID and cancer, all through the human interactions and everything that is changing on a clinical level, but also on a personal level. So the first part of the review is really about the biological aspects. It's how do COVID and cancer interact and why we think on a biological level are patients with cancer more at risk of COVID, which is what we are unfortunately seeing on the clinical level, and can we explain that? Because if we can understand it, we can maybe actually take action against that and try to improve patient outcomes. So we try to cover that, we cover the interactions in terms of infection, increased risk of infection. We then cover the interaction at the immune level. We are seeing some very peculiar, I would say, immune characteristics or immune response characteristics in patients who contract COVID and there is a particular immune system in patients with cancer. So we tackle that. Then we talk about interactions at the thrombotic level. We know that patients with COVID, unfortunately, have an increased risk of intramosis and this is also true for patients with cancer. So we also discuss the details of that and how the two can play out together.
The second part of our review is talking about testing, how should we identify patients with cancer? How should we try to detect COVID? When should we test them? How should we test them? We cover that.
The third part is about changes in cancer care delivery. So we've been talking a lot about how do we take care of COVID in patients with cancer in general, but also how do we take care of patients? How do we take care of patients with cancer and their cancer, which is obviously being often, I would say, forgotten or less emphasized in the midst of a pandemic, but we can see the consequences of that becoming more and more apparent as the pandemic drags on. We talk about taking care of patients with cancer but also screening and detecting new cancers.
Fourth, and I think most relevant to the COVID-19 cancer consortium, we discuss the prognostic factors of patients with cancer. I think this is super important because patients with cancer is sort of a very large heterogeneous group and identifying prognostic factors and risk stratifying patients with cancer with the cost of COVID-19 outcomes is important. So we talk about clinical prognostic factors and also biomarkers of adverse outcomes.
And fifth and I think importantly is the impact on cancer research. This is important for cancer researchers and clinicians like all of us, I think, who have been impacted on a personal level, but also on a professional level by this pandemic. We try to talk about the impacts on cancer funding, which has been pronounced particularly for philanthropic funding and try to highlight that as well as the disproportionate effect on early-career scientists and potentially certain groups of scientists who are part of particular groups who may be disproportionally affected.
Alicia Morgans: All really important, and certainly the review has all of these main points, packs a lot of punch, and really gives us food for thought, as we continue to care for these patients. I'm wondering if each of you could give, I guess, a take-home point or a main message that you hope that readers and listeners will glean from this review. Corrie, why don't we start with you?
Corrie Painter: Sure. Thanks so much. One of the main points for me being part of this was the sheer volume of information that was available in such a short period of time and the way that scientists all over the world have come together in order to champion our knowledge at the interface of cancer and COVID. This is true of the consortium that we are part of with the CCC19, where you have individual people and organizations that are coming together to provide data at a per-patient level, as well as scientists who have taken it upon themselves to really review and understand the state of where we are with respect to these two diseases in order to provide the publications that we use to write this paper. It really speaks to the ability of people to collaborate and to rapidly-produce information that is vitally important to the understanding of both of these diseases today.
Alicia Morgans: Wonderful and I think before we even signed on, you had one more message that I don't want us to avoid saying, what was that, Corrie?
Corrie Painter: I think, though it was not its own section in this review. That it is very important for everybody to wear a mask. Thank you.
Alicia Morgans: Thank you. I agree with you. I think all the docs in the world agree with you. So thank you for emphasizing that point as we struggle through what we deal with on a day-to-day basis and thank you for those points. Jessica, can you share with us your main points, please?
Jessica Hawley: Of course. So one of my takeaways when working on this review was to recognize all the ways in which we have become more intentional about taking care of our patients with cancer right now in the setting of the pandemic, and I think many of the things that we are doing now are worth perpetuating forward because we've seen such great uptake in things and patient satisfaction. And what I mean by that is, just being more flexible overall, I would say with scheduling and we've seen other cancer centers take up telehealth in ways that they never really anticipated. And from a clinical trial investigation side, I think a lot of things have become extremely less rigid with respect to scheduling and flexibility and protocol deviations and e-signatures. And so all of these things I think are positive lessons that we have learned from living in the pandemic, taking care of patients, and are things that we should be proactive and intentional about moving forward.
Alicia Morgans: I completely agree and I think from a patient perspective, their voices have been loud and clear that they have sincerely appreciated the flexibility that we have been able to offer. Not only in clinical care, as you mentioned, but of course, in our clinical trials and the way that we are able to try to get them these newest therapies and engage in clinical research, which is the best way I think, to continue to move the field forward despite the pandemic. So wonderful messages, and Ziad, what would the message be from you?
Ziad Bakouny: Yes, I think building on the positive messages by Corrie and Jessica, the positive message from a biological perspective, in my sense, was the number of new things we've learned building off of cancer research to be able to help patients with COVID-19 in general, not just those with cancer. I'll cite two examples. One of them is the biology of TMPRSS2, which has long been studied by GU oncologists, and particularly researchers interested in prostate cancer since TMPRSS2 is a gene or a protein that is heavily implicated in prostate cancer biology and so just understanding how TMPRSS2 is regulated and how it can be affected in terms of expression has helped improve the care, or at least we are trying to help improve the care of patients with COVID-19 based on this knowledge because TMPRSS2 is implicated in the internalization of SARS-CoV-2.
Another example is the cytokine release syndrome and how we've been able to learn from that. Cytokine release syndrome is obviously well described in patients that are treated by CAR-T cell therapies in patients with cancer in the cancer setting, I would say, how that has been treated and how the therapies that we use for that are trying to translate those into treatments for patients with the cytokine storm and COVID-19 is sort of another positive. I hope these will bear fruit, but I think they are both promising and interesting and how that has come from the cancer research space to the COVID-19 research space is the main positive I've taken away.
Alicia Morgans: So many positive things despite an overall, extremely trying experience. But I sincerely appreciate the way that all of you are taking the information that we have and leveraging that to be something positive, to do something positive for our patients and I sincerely look forward to the follow-up paper maybe a year from now when the paper will include many more answers and some future directions for us as we continue to move forward in a world that is not going to get rid of SARS-CoV-2. COVID-19 as an illness will be here with us and I am just very grateful that all of you have taken the time to put all of the information that we have in a roadmap and a direction for the future together for us so that we have a way to go. So thank you all for your work and thank you so much for your time this evening.
Jessica Hawley: Thank you so much.
Ziad Bakouny: Thank you very much, Alicia.