COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

  1. Institut Curie Breast Cancer and COVID Group
  2. Perrine Vuagnat
  3. Maxime Frelaut
  4. Toulsie Ramtohul
  5. Clémence Basse
  6. Sarah Diakite
  7. Aurélien Noret
  8. Audrey Bellesoeur
  9. Vincent Servois
  10. Delphine Hequet
  11. Enora Laas
  12. Youlia Kirova
  13. Luc Cabel
  14. Jean-Yves Pierga
  15. Laurence Bozec
  16. Xavier Paoletti
  17. Paul Cottu
  18. François-Clément Bidard

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background

Cancer patients have been reported to be at higher risk of COVID-19 complications and deaths. We report the characteristics and outcome of patients diagnosed with COVID-19 during breast cancer treatment at Institut Curie hospitals (ICH, Paris area, France).

Methods

An IRB-approved prospective registry was set up at ICH on March 13, 2020, for all breast cancer patients with COVID-19 symptoms or radiologic signs. Registered data included patient history, tumor characteristics and treatments, COVID-19 symptoms, radiological features, and outcome. Data extraction was done on April 25, 2020. COVID-19 patients were defined as those with either a positive RNA test or typical, newly appeared lung CT scan abnormalities.

Results

Among 15,600 patients actively treated for early or metastatic breast cancer during the last 4 months at ICH, 76 patients with suspected COVID-19 infection were included in the registry and followed. Fifty-nine of these patients were diagnosed with COVID-19 based on viral RNA testing ( N  = 41) or typical radiologic signs: 37/59 (63%) COVID-19 patients were treated for metastatic breast cancer, and 13/59 (22%) of them were taking corticosteroids daily. Common clinical features mostly consisted of fever and/or cough, while ground-glass opacities were the most common radiologic sign at diagnosis. We found no association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. Twenty-eight of these 59 patients (47%) were hospitalized, and 6 (10%) were transferred to an intensive care unit. At the time of analysis, 45/59 (76%) patients were recovering or had been cured, 10/59 (17%) were still followed, and 4/59 (7%) had died from COVID-19. All 4 patients who died had significant non-cancer comorbidities. In univariate analysis, hypertension and age (> 70) were the two factors associated with a higher risk of intensive care unit admission and/or death.

Conclusions

This prospective registry analysis suggests that the COVID-19 mortality rate in breast cancer patients depends more on comorbidities than prior radiation therapy or current anti-cancer treatment. Special attention must be paid to comorbidities when estimating the risk of severe COVID-19 in breast cancer patients.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.04.30.20085928: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Registry: The prospective COVID-19 registry was approved by the ICH institutional review board, which waived documentation of informed consent due to its observational nature.
    Consent: Registry: The prospective COVID-19 registry was approved by the ICH institutional review board, which waived documentation of informed consent due to its observational nature.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of our study is that some patients may have been treated by their family physicians or referred to local hospitals, without any notification to ICH. Although no data was available to compare COVID-19 patients to the other breast cancer patients seen at ICH, rates of high BMI and hypertension in our COVID-19 patient cohort were very similar to those reported in a recent prospective large-scale report on French breast cancer patients [20], suggesting that these comorbidities do not increase the risk of COVID-19. Our analyses showed that breast cancer patients have similar clinical and radiologic features of COVID-19 to those previously described in other reports on non-cancer COVID-19 patients. Importantly, we found no trend in favor of a relationship between a history of breast and lymph node radiation therapy, radiation therapy sequela and radiologic extent of disease or outcome. Thrombotic, cardiovascular, microvascular and dermatological events were not recorded, as their association with COVID-19 was not fully recognized when the registry was set up. In terms of COVID-19 outcome, we observed a non-negligible mortality rate of 6.7% (4/59) among breast cancer patients diagnosed with COVID-19, with a higher mortality rate of 9.7% (4/41) in the RNA-positive subgroup. As of April 26th, the reported mortality rate among RNA-positive patients in the general population ranges from 18.2% in France to 5.6% in the USA and 3.7% in Germany [4]. However, these percentages r...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1186/s13058-020-01293-8
  3. Version published to 10.1101/2020.04.30.20085928v2 on medRxiv
  4. Version published to 10.1101/2020.04.30.20085928v1 on medRxiv