bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract PO-193: Gender, women, and lung cancer: Times are changing
Authors: Tandon Radhika , Stanifer B. Payne , D'Ovidio Frank , Saqi Anjali , Sonett Joshua
Published: December 2020

Objective Recent literature has indicated a shift in the pattern of incidence rates of lung cancer among men than among women in non-Hispanic whites and Hispanics born since the mid-1960’s. These changes are not fully explained by differences in smoking behaviors. The goal of our study is to determine the role, if any, of race on lung cancer in never-smokers in patients undergoing lung cancer surgery. Methods Our institutional database (Columbia University Medical Center) was queried from 2006 to 2018 for all patients undergoing lung cancer surgery. A total of 1631 cases of NSCLC were reported. We analyzed the cohort for differences in basic demographics, including sex, race, and smoking status. Results In Hispanic, Asian, and Black, but not White populations undergoing lung cancer surgery, non-smokers were significantly more likely to be women (p=0.01, 0.00001, 0.03). The proportion of never-smoking patients in men and women is dependent on race in Asian, Black, Hispanic, Non- Hispanic White, and all White populations (p=0.09). Conclusions The varying epidemiology of male and female lung cancer patients shows significant differences, by smoking status and race. This emphasizes the necessity for further research into the pathogenesis of nonsmoking related lung cancer. Our further research will utilize genomic analysis and multi-institutional statistical analyses to further investigate these differences.

Citation Format: Radhika Tandon, B. Payne Stanifer, Frank D'Ovidio, Anjali Saqi, Joshua Sonett. Gender, women, and lung cancer: Times are changing [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-193.
Abstract PO-209: Breast cancer survival disparities by insurance status or racial/ethnic in specific patient populations
Authors: Wang Kaicheng , Hu Jennifer J. , Reis Isildinha M. , Zhao Wei , Yang George R. , Herna Stuart
Published: December 2020

Introduction: Health insurance status reflects patients’ socioeconomic status, which determines healthcare access and is associated with prognosis and survival. Limited research has reported the association between insurance status and breast cancer survival, potentially mediated through healthcare access. Method: Tumor registry data from University of Miami Health System and Jackson Memorial Hospital between 2008 to 2018 were used to estimate the association between race/ethnicity, insurance status and tumor stage at diagnosis; effect of insurance status on the likelihood of receiving specific breast cancer treatment; and overall survival by race/ethnicity and insurance status. Overall, 4392 breast cancer patients were included in the study. Odds ratios (ORs) and 95% confidence intervals (CIs) for the likelihood of being diagnosed with advanced stage breast cancer by race/ethnicity and insurance status, and likelihood of receiving specific treatments by insurance status and race/ethnicity were evaluated. Five-year overall survival probabilities and hazard ratios (HRs) by race/ethnicity and insurance status were also examined. Results: African-American patients and patients who had Medicaid or were uninsured were more likely to be diagnosed with advanced stage breast cancer. Under-coverage patients were less likely to receive cancer-specific treatment. Five- year survival rate was significantly lower in African-Americans compared to non- Hispanic whites (74.2% and 85.7%; p<.001). Overall survival was also significantly worse in African-Americans compared to non-Hispanic Whites (HR, 1.40; 95%CI, 1.12-1.76). Patients who had Medicare (<65 years of age) (HR, 1.84; 95%CI, 1.19- 2.86) or Medicaid (HR, 1.23; 95%CI, 1.00-1.51) had significantly worse survival compared to patients with private insurance. Among HER2 positive patients, those who were covered by Medicare (≥65 years) (HR, 3.02; 95%CI, 1.04-8.80), Medicaid (HR, 2.31; 95%CI, 1.14-4.69), or no insurance (HR, 3.02; 95%CI, 1.44-6.32) had significantly higher hazards of death than privately insured patients. Conclusions: This study identified Medicare, Medicaid, and uninsured patients as having higher hazards of death compared to privately insured patients, which can inform health professionals and policy makers to advocate for equal health outcomes regardless of insurance.

Citation Format: Kaicheng Wang, Jennifer J. Hu, Isildinha M. Reis, Wei Zhao, George R. Yang, Stuart Herna. Breast cancer survival disparities by insurance status or racial/ethnic in specific patient populations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-209.
Abstract PO-222: Co-morbid risk factors and NSAID use among white and black Americans that predicts overall survival from diagnosed colon cancer
Authors: Koi Minoru , Okita Yoshiki , Koeppe Erika , Stoffel Elena M. , Galanko Joseph A. , McCoy Nikki , Keku Temitope , Carethers John M.
Published: December 2020

Black Americans (BA) have higher incidence and higher mortality rates for colorectal cancers (CRC) as compared to White Americans (WA). While there are several identified risk factors associated with the development of CRC and evidence that high levels of adequate screening can reduce differences in incidence for CRC between BA and WA, there remains little data regarding patient co-morbid contributions towards survival once an individual has CRC. Here we set out to identify patient risk factors that influenced overall survival in a cohort of 293 BA and 348 WA with colon cancer, ages 40 to 84 years old, with at least 10 years of follow- up. We utilized the logistic regression test for statistical associations, the Kaplan- Meier method with log rank test for survival analyses, and Cox Proportional Hazards Models for covariate independence. Amid our cohort, we found that patients’ age, tobacco usage, and pre-diagnosed medical conditions such as hypertension and diabetes were associated with shorter overall survival (OS) from colon cancer. We identified pre-diagnosed hypertension (19.6% contribution) and diabetes (12% contribution) among BA were together responsible for nearly one-third of the colon cancer mortality disparity compared with WA. We also identified long-term regular use (>5 years aggregated years of drug use) of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, was associated with shorter OS from colon cancer among WA >65 years of age (Hazard Ratio 1.76, 95% confidence interval 1.12-2.77), but not younger WA patients or any aged BA patients. Our results raise the importance of not only treating the colon cancer itself, but also taking into consideration co-morbid medical conditions and NSAID usage to enhance patient OS. Further evaluation regarding adequate treatment of co-morbidities and timing of NSAID continuance after cancer therapy will need to be studied.

Citation Format: Minoru Koi, Yoshiki Okita, Erika Koeppe, Elena M. Stoffel, Joseph A. Galanko, Nikki McCoy, Temitope Keku, John M. Carethers. Co-morbid risk factors and NSAID use among white and black Americans that predicts overall survival from diagnosed colon cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-222.
Abstract PO-248: Breast cancer risk factors, prevalence, and screening rates in uninsured women seen at free clinics
Authors: MacDonald Madeline , Swanson Justin , Shah Shreni , Vivar Jhulianna , Song Ethan , Ahsan Tanzila , Mhaskar Rahul , Mirza Abu-Sayeef
Published: December 2020

Introduction: Uninsured women face increased barriers to obtaining age appropriate breast cancer screening. Despite the National Breast and Cervical Cancer Early Detection Program which provides breast cancer screening services to uninsured women below the federal poverty level, a majority of uninsured women still do not receive screenings. As a result, uninsured women are at risk of presenting with more advanced cancer. The purpose of this study is to identify risk factors, prevalence, and screening rates for breast cancer among uninsured women seen at free clinics.

Methods: A retrospective chart review was conducted to collect demographics, risk factors, breast cancer prevalence, and screening rates from medical records at ten free clinics in the Tampa Bay area of Florida from January 1st 2016-December 31st 2018. Uninsured women above the age of 45 were included in the study, in accordance with the American Cancer Society’s recommendation to begin screening women of average breast cancer risk by that age. Results: A total of 3721 women over the age of 45 were seen at free clinics during the study period. The mean age was 56.0 (SD=7.8). This sample was largely composed of Hispanic (n=1466, 47.6%) and unemployed (n=845, 46.2%) women. The mean (SD) BMI of patients was 30.5 (7.8). Of those with a recorded substance use history, 433 (18.7%) were current smokers and 454 (24.3%) were current alcohol consumers. Mammograms were documented for 838 (22.5%) of patients above the age of 45 years. The prevalence of breast cancer was 2.0% (n=73). Conclusions: Our study identifies a population of uninsured women who are at risk for breast cancer based on specific risk factors including age, BMI, smoking history, and alcohol use. Uninsured women seen at free clinics have suboptimal breast cancer screening rates. Our study population is largely comprised of Hispanic, unemployed, and low-income women who face additional healthcare barriers putting them at risk of advanced stage breast cancer. Our study increases awareness of an at-risk population, and increased efforts need to be made to provide uninsured women with age appropriate breast cancer screening in order to reduce morbidity and mortality.

Citation Format: Madeline MacDonald, Justin Swanson, Shreni Shah, Jhulianna Vivar, Ethan Song, Tanzila Ahsan, Rahul Mhaskar, Abu-Sayeef Mirza. Breast cancer risk factors, prevalence, and screening rates in uninsured women seen at free clinics [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-248.
Abstract PO-255: A colorectal cancer screening intervention to help increase screening rate within the Harris Health safety-net health care system
Authors: Rosen Allison , Chenier Roshanda , Montealegre Jane , Jibaja-Weiss Maria
Published: December 2020

Background: Colorectal Cancer (CRC) is often preventable through regular screening. CRC screening is an evidence-based intervention for early detection and prevention of CRC. However, screening rates are low among medically underserved, minority populations. In collaboration with a local safety-net healthcare system and community clinics, we are implementing a comprehensive, multi-modal CRC prevention program. Our CRC screening program includes community outreach, culturally and linguistically targeted educational point-of-care patient education videos, patient navigation services, and provider and staff training. In 2018, a new component was introduced that includes a CRC survivor led provider-targeted assessment intervention leveraging the American Cancer Society National Colorectal Roundtable’s “80% in Every Community” campaign. Methods: As part of the 80% in Every Community campaign, providers and clinical staff are trained by the CRC survivor staff member to employ strategies from the Roundtable’s toolkit to heighten clinic-level commitment to improving screening rates. Specific strategies include providing tips for evidence-based messaging to reach the unscreened, and training providers to consistently give a strong CRC screening recommendation. A baseline survey was administered ahead of the initial training to assess current clinical practices. Results: Survey data indicated 84.3% (N= 297, 14 clinics) of respondents identified patients not completing and returning FIT as a screening barrier (61.7%-Sometimes and 22.7%-Usually). When asked if they had mechanism to ensure patients given a FIT kit have completed and returned them -75.7 % said Yes and 24.3%-No. In the follow-up question, asking if they had a mechanism to ensure FIT were completed and returned, responses showed: 13.9 % said no mechanism, 43.0% reminder call, 8.1% mail reminder, and 28.6% said a chart reminder to return kit at next visit. 73 respondents wrote in various other mechanisms. Discussion: Respondents believed a systematic mechanism already existed to remind patients to complete their FIT and return it to their clinic. Our next steps are to present these findings to health system leadership and investigate the possibility to strengthen screening patient reminders in various forms of communication to increase FIT completion rate.

Citation Format: Allison Rosen, Roshanda Chenier, Jane Montealegre, Maria Jibaja-Weiss. A colorectal cancer screening intervention to help increase screening rate within the Harris Health safety-net health care system [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-255.
Abstract PR15: CanSplice: A user-friendly web application for analysis of genomic datasets by race and ethnicity
Authors: Abo Muthana Al , Patierno Steven R. , Freedman Jennifer A.
Published: December 2020

The rate of cancer incidence and mortality differ in populations of different ancestry. Comparative analyses of cancer specimens have identified race- and ethnicity-related differential mutation spectra and gene expression, RNA splicing, and epigenetic patterns. These findings suggest that race- and ethnicity-related molecular mechanisms have the potential to contribute to cancer aggressiveness in individuals of different racial and ethnic groups. Advances in technology have enabled researchers to perform high-throughput genome-wide analyses of cancer specimens, including of the exome, transcriptome, proteome, and methylome. Such analyses have generated large amounts of data, which can be challenging for many cancer researchers to analyze. In addition, although many user-friendly tools have been developed for mining big data, there is an urgent need for tools that enable the mining of big data by patient race and ethnicity. Here, we developed a user-friendly online application, CanSplice, that enables the cancer disparity research community to interactively navigate and visualize genomic datasets and perform comparative and correlative analyses. Additionally, researchers using CanSplice can evaluate the association between genomics and patient survival probability in the context of patient race and ethnicity. Uniquely, CanSplice enables exploration of RNA splicing datasets by race and ethnicity and analysis of the association between a given RNA splicing event and patient survival probability. Currently, CanSplice includes data from The Cancer Genome Atlas (TCGA) and TCGASpliceSeq; however, new data from additional cohorts will be added continuously. In conclusion, CanSplice is a user-friendly online application that enables innovative exploration of publicly available cancer genomic datasets by patient race and ethnicity for hypothesis generation. Identified targets can then be validated and investigated for functionality in the laboratory. Thus, data from CanSplice will further understanding of molecular mechanisms underlying cancer disparities and has the potential to aid in the development of novel precision medicine interventions to mitigate cancer disparities.

Citation Format: Muthana Al Abo, Steven R. Patierno, Jennifer A. Freedman. CanSplice: A user-friendly web application for analysis of genomic datasets by race and ethnicity [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR15.
Abstract IA16: COVID-19 pandemic and its effect on the psychological status of cancer patients and oncologists
Authors: Pravettoni Gabriella
Published: December 2020

On the 11th of March, the Word Health Organization declared COVID-19 a pandemic. This unprecedented emergency caused some unexpected effects on the health care system. During the pandemic, the attention focused on keeping cancer patients safe from COVID-19. This infection could have a detrimental effect on the physical and mental health of cancer patients; patients who have a suspension of cancer care suffer more from anxiety and/or depression. One of the worst side effects of COVID-19 is the fact that family members could not visit patients; social support in cancer patients is an important factor for a healthy mental condition. With no social support, their normal coping strategies have to adapt and the feeling of helplessness is overwhelming. These aspects are highlighted by a case report of a European Institute of Oncology patient. After a surgical intervention due to oral tongue cancer, he was diagnosed with COVID-19 infection and this caused anxiety and depression symptoms. During the pandemic, health care professionals’ (HCP) role has been pivotal: HCP had to cope with a stressful working environment, facing physical and psychological challenges. Oncologists, in particular, in their daily practice are at risk of developing burnout symptoms and post-traumatic stress disorder symptoms and this could be exacerbated by the pandemic. During pandemic phase 1, we evaluated emotional distress and mental health of oncologists all over the world. Our results showed a low mental health status and distress regarding emotional status; oncologists revealed that fear is one of the most diffuse emotions during pandemic. They are afraid for their patients during the hospital hours, and, when they leave the hospital ward, they feel fear for their family members and cohabitants, in a never-ending feeling of dread. This condition, if prolonged, could be a stressor that could lead to burnout syndrome and post-traumatic stress disorder. For these reasons, it is important to care for the oncologists who had cared for their patients, often prioritizing it over their own well-being. In these particular times, new technologies can help both patients and oncologists. In this complex scenario, the role of the oncologists becomes more and more important; new technologies’ output must be interpreted and technologies have to be at the service of humans, not vice versa. This should help oncologists to perform the integration of a big amount of diverse data otherwise impossible to put together meaningfully.

Citation Format: Gabriella Pravettoni. COVID-19 pandemic and its effect on the psychological status of cancer patients and oncologists [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr IA16.
Abstract PO-046: Assessment of COVID-19 vaccine candidates: Prediction and validation of 174 SARS-CoV-2 epitopes
Authors: Prachar Marek , Justesen Sune , Steen-Jensen Daniel Bisgaard , Thorgrimsen Stephan , Jurgons Erik , Winther Ole , Bagger Frederik Otzen
Published: December 2020

The recent outbreak of SARS-CoV-2 (2019-nCoV) virus has highlighted the need for fast and efficacious vaccine development. Stimulation of a proper immune response that leads to protection is highly dependent on presentation of epitopes to circulating T-cells via the HLA complex. SARS-CoV-2 is a large RNA virus and testing of all of its overlapping peptides in vitro to deconvolute an immune response is not feasible. Therefore, HLA-binding prediction tools are often used to narrow down the number of peptides to test. We tested 19 epitope-HLA-binding prediction tools, and using an in vitro peptide-MHC stability assay, we assessed 777 peptides that were predicted to be good binders across 11 MHC alleles. In this investigation of potential SARS-CoV-2 epitopes, we found that current prediction tools vary in performance when assessing binding stability, and they are highly dependent on the MHC allele in question. Designing a COVID-19 vaccine where only a few epitope targets are included is therefore a very challenging task. Here, we present 174 SARS-CoV-2 epitopes with high prediction binding scores, validated to bind stably to 11 HLA alleles. Our findings may contribute to the design of an efficacious vaccine against COVID-19.

Citation Format: Marek Prachar, Sune Justesen, Daniel Bisgaard Steen-Jensen, Stephan Thorgrimsen, Erik Jurgons, Ole Winther, Frederik Otzen Bagger. Assessment of COVID-19 vaccine candidates: Prediction and validation of 174 SARS-CoV-2 epitopes [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-046.
Abstract PO-050: Computational modeling of immunologic response to immune checkpoint inhibitors in COVID-19 patients with and without cancer
Authors: Russo Giulia , Falzone Luca , Cacopardo Bruno , Nunnari Giuseppe , Torino Francesco , Scandurra Giuseppa , Stefani Stefania , Pappalardo Francesco , Libra Massimo
Published: December 2020

Cancer patients have an increased risk of severe COVID-19 infection due to the suppression of the immune system and the development of cytokine release syndrome (CRS) that favor respiratory syndromes and interstitial pneumonia. However, substantial differences exist between patients treated with chemotherapy and patients treated with immune checkpoint inhibitors (ICIs), for which the risk of COVID-19 infection and the immunologic and cytokine profile in case of infection have not yet been well characterized. The administration of ICIs for the treatment of severe COVID-19 infection has been recently suggested. However, no conclusive data have been generated on this matter. To recognize the therapeutic potential of ICIs administration in COVID-19 patients with or without cancer, the Universal Immune System Simulator (UISS) prediction model was used to simulate the immunologic response of COVID-19 patients after ICIs administration. Briefly, UISS represents an appropriate computational modeling infrastructure able to simulate the dynamics of every single entity of the immune system after a stimulus or a therapeutic intervention by using an agent-based methodology. Therefore, the UISS platform, already used for the prediction of the efficacy of specific SARS-CoV-2 candidate vaccines, was here adopted to characterize the immunologic behavior in both COVID-19 and cancer patients and to predict the effects of ICIs in these patients. The computational results allowed us to identify key inflammatory and immune-related factors responsible for severe respiratory syndromes in COVID-19 infected patients with and without cancer. UISS results suggest that the administration of ICIs modulates the immune system and the inflammatory status in both groups of patients with COVID-19 infection, reducing the risk of severe symptoms. Although the results of the present study are still under validation in peripheral blood samples obtained from COVID-19 patients and from cancer patients after two cycles of treatment with ICIs, we can speculate that ICIs may be a good therapeutic approach for the treatment of COVID-19 severe respiratory syndrome even with a concomitant cancer diagnosis. If this is the case, the lower expression levels of inflammatory biomarkers can result in the drop-down of the viral load, assessed by droplet digital PCR in COVID-19 patients.

Citation Format: Giulia Russo, Luca Falzone, Bruno Cacopardo, Giuseppe Nunnari, Francesco Torino, Giuseppa Scandurra, Stefania Stefani, Francesco Pappalardo, Massimo Libra. Computational modeling of immunologic response to immune checkpoint inhibitors in COVID-19 patients with and without cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-050.
Abstract PO-051: Intracellular delivery of nuclear localization signal suppresses COVID-19 mediated inflammation by regulating expression of cytokines/chemokines
Authors: Lee Danbi , Yu Sanghyeon , Baek Misuk , Kim Jieun , Kang Mingu , Park Hakyoung , Lee Jaewook , Lee Seokwon , Kwak Junghun , Yu Hyemin , Lee Seungwoo , Kim Sujeong , Lee Hyewon , Shin Dasom , Kim Boram , Jung Minyoung , Choi Youngsil , Jo Daewoong , Kim Gyunam , Kim Dongho
Published: December 2020

The outbreak of coronavirus disease 19 (COVID-19), caused by the recently identified coronavirus named SARS-CoV-2, is leading patients to death (mortality: ~7%) because of cytokine storm. COVID-19 induces excessive secretion of proinflammatory cytokines and chemokines accompanied by the disruption of the bronchi and alveoli, which could ultimately develop into permanent lung impairments such as pulmonary fibrosis. To regulate the uncontrolled expression of proinflammatory cytokines/chemokines, improved cell-permeable nuclear import inhibitor (iCP-NI) has been developed by fusing sequence-optimized hydrophobic cell-penetrating peptide (CPP), namely advanced macromolecule transduction domain (aMTD) with nuclear localization signal (NLS) of stress responsive transcription factors (SRTFs: NF-κB, STAT1/3, AP-1, and NFAT). Intracellularly delivered NLS is supposed to suppress expression of proinflammatory cytokines/chemokines by inhibiting transport of SRTFs from cytoplasm into nucleus. iCP-NI regulated expression of cytokines (TNF-α: -79%, IL-6: -91%, IL-12: -110% and IL-10: +574%) and chemokines (MCP-1: -89%) in bronchoalveolar lavage fluids (BALFs) from RNA virus infection mimetic pneumonitis animals that were induced with inhalation of RNA structure molecule, poly I:C. iCP-NI also significantly decreased pulmonary fibrosis (-61%) in bleomycin-induced pulmonary fibrosis animals. Moreover, iCP-NI protected leukocytes (CD3+ T cell: 100%, CD4+/CD3+ T cell: 96%, B220+ B cell: 85%, CD45+ macrophage: 100%) and reduced apoptotic splenocytes (-97%) in staphylococcal enterotoxin B (SEB) and poly I:C-induced acute pneumonitis animals. These results suggest that iCP-NI has potential as a novel therapeutic measurement for inflammation caused by various infectious diseases including COVID-19 accompanied with cytokine storm and severe sepsis.

Citation Format: Danbi Lee, Sanghyeon Yu, Misuk Baek, Jieun Kim, Mingu Kang, Hakyoung Park, Jaewook Lee, Seokwon Lee, Junghun Kwak, Hyemin Yu, Seungwoo Lee, Sujeong Kim, Hyewon Lee, Dasom Shin, Boram Kim, Minyoung Jung, Youngsil Choi, Daewoong Jo, Gyunam Kim, Dongho Kim. Intracellular delivery of nuclear localization signal suppresses COVID-19 mediated inflammation by regulating expression of cytokines/chemokines [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-051.
Abstract PO-056: Using MammaPrint to reduce the need for chemotherapy in early breast cancer during the COVID-19 pandemic
Authors: Murray Elizabeth M. , Myburgh Ettienne J. , Lujinovic Ersan , Mittempergher Lorenza , Robertson Duncan J. , de Jager Josephus J. , Kotze Maritha J.
Published: December 2020

Introduction: With the recent worldwide outbreak of COVID-19, it became clear that certain comorbidities are associated with an increased risk of complications and death. Several publications have reported an increased rate of ICU admission and mortality in cancer patients. This has led to guidelines advising more conservative approaches to cancer therapy, including chemotherapy. In the absence of prospective, disease-specific outcome data, there is a risk of overestimating the risk of COVID-19 and thus increasing cancer-specific mortality or of underestimating. MammaPrint has been validated for selecting clinically high-risk breast cancer patients in whom chemotherapy can be avoided safely.

Methods: We evaluated the current published literature related to the potential risk of breast cancer and chemotherapy in association with COVID-19. We estimated the potential risk of severe events in COVID-19 breast cancer patients receiving adjuvant chemotherapy to assess whether MammaPrint could help us further in making chemotherapy decisions specific to an infectious epidemic risk.

Results: The risk of COVID-19 morbidity and mortality in patients receiving chemotherapy could be greater than 1.5 to 2 times higher than usual. However, other associated conditions frequently found in the breast cancer population seem to still play a significant role in a worse outcome. We found no data to quantify the effect of chemotherapy or data allowing us to adapt the MammaPrint Score to risk in an infectious epidemic.

Conclusion: Adjuvant chemotherapy carries a potential risk for morbidity and mortality. Data from the current literature do not show the magnitude of the added risk for breast cancer patients on adjuvant chemotherapy in association with SARS Cov-2 infection. By using MammaPrint in hormone receptor-positive patients with up to three nodes in whom chemotherapy is considered, the treatment-related risk can be limited, allowing safe de-escalation of therapy without increased cancer-specific mortality. We plan to pursue the statistical question of how the level of risk at any of the sites on the spectrum relates to distant metastasis-free survival so that mortality risks can be better estimated during an infection.

Citation Format: Elizabeth M. Murray, Ettienne J. Myburgh, Ersan Lujinovic, Lorenza Mittempergher, Duncan J. Robertson, Josephus J. de Jager, Maritha J. Kotze. Using MammaPrint to reduce the need for chemotherapy in early breast cancer during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-056.
Abstract PO-062: Early impact of COVID-19 in cancer care: The experience of a Brazilian outpatient clinic
Authors: Sternberg Cinthya , Vivas Bianca , Andrade Thamine Lessa , Nova Ana Paula Vila , Fernandes Ana Paula , Alves Camila , Alvez Adriana , Hizumi Lise , Dias Simone , Nobre Pablicio , Calabrich Aknar , Coutinho Anelisa , Pimenta Alex
Published: December 2020

The first confirmed case of coronavirus disease 2019 (COVID-19) in Latin America was reported on February 25th, 2020, in Brazil. As COVID19 disease incidence escalated in the country, management of cancer patients required immediate action and oncology clinics were urged to establish a contingency plan. We were the first oncology clinic in Brazil to install a COVID-19 Management Committee to elaborate and implement best practices to assist cancer outpatients as well as to provide a safe environment for clinical staff and other employees at the outpatient clinics. We started monitoring our staff and employees on March 13th, a day after we installed a contingency plan for COVID-19 management and WHO declared COVID-19 a pandemic. So far, out of 1,022 staff and employees of our group, we have registered 12.3% suspected and 3.8% confirmed COVID-19 cases, and only 1 case severe enough to require hospitalization. As COVID-19 testing is not widely available, not all patients were tested and/or we did not have access to results, as tests might have been conducted somewhere other than the clinic. Out of 98 patients with suspected COVID-19 being monitored by SCIA (ranging from 29 to 90yo), 68% were tested and 43% of these were positive. As for the monitored population (n=98), 62.6% were undergoing treatment, 31.8% tested positive, and 9.9% died due to COVID-19 (31% of the confirmed cases, matching literature data). All deaths by COVID-19 (n=9) occurred in patients above 68yo, and 77% (n=6) were undergoing cancer treatment. To the best of our knowledge, this is the first report of COVID-19 incidence in cancer patients in Brazil. The challenges of cancer treatment in the midst of a global pandemic highlight the importance of a rapid response by institutions, where organizational structure, strategic planning, agility in guidelines implementation, and alternative ways to protect and support clinical staff, employees, and patients may be the keys to mitigate pandemic effects.

Citation Format: Cinthya Sternberg, Bianca Vivas, Thamine Lessa Andrade, Ana Paula Vila Nova, Ana Paula Fernandes, Camila Alves, Adriana Alvez, Lise Hizumi, Simone Dias, Pablicio Nobre, Aknar Calabrich, Anelisa Coutinho, Alex Pimenta. Early impact of COVID-19 in cancer care: The experience of a Brazilian outpatient clinic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-062.
Abstract PO-070: What kills patients with severe Covid-19 might also kill patients with terminal cancer
Authors: Zhang Lingbing
Published: December 2020

Introduction: As a prominent clinical feature of severe Covid-19, cytokine storm has attracted enormous attention recently. It is generally believed that cytokine storm might be the underlying force leading to health exacerbation and death from severe Covid-19. However, the role of cytokine storm in terminal cancer has not been reported. In this study, we investigated the role of cytokine storm in a murine tumor model that mimics the disease progression of terminal cancer. We found that cytokine storm develops in terminal cancer and leads to cachexia, which is a prevalent and lethal syndrome of terminal cancer.

Methods: 7-week old BALB/c mice were inoculated with 1 x106 C26 tumor cells subcutaneously. Mice body weight and health condition were monitored starting 7 days after tumor inoculation. At various time points, serum cytokines were measured, immune cells were analyzed with flow cytometry, and multiple organs were collected and processed for histopathologic assessment.

Results: Growth of subcutaneously inoculated tumors without metastasis progressively induces host body weight loss and overall health deterioration. Cytokine storm characterized by elevated expression of multiple proinflammatory cytokines such as IL-1, IL-6, and TNF-a in blood develops accompanying the health deterioration. In parallel with cytokine storm development, massive infiltration of Gr-1 positive cells occurs in vital organs (lung and liver) and brings severe tissue damage. Histopathologic check ruled out any tumor metastasis to these organs, which suggests that the inflammatory response is the cause of the multiple organ damage. Importantly, suppression of the inflammatory response with interventions can completely reverse the cachexia syndrome and increase survival.

Conclusions and Implication: Cytokine storm develops and plays an important role in the health exacerbation of terminal cancer. Therefore, calming the cytokine storm with interventions that can suppress the inflammatory response might represent a new and promising approach to the treatment of terminal cancer. This approach may have the potential to save many patients from imminent deaths, which are often not directly caused by organ occupation.

Citation Format: Lingbing Zhang. What kills patients with severe Covid-19 might also kill patients with terminal cancer [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-070.
Abstract PO-072: Doctors and nurses during COVID19 pandemic: A different perception of cancer care
Authors: Bastianelli Lucia , Merloni Filippo , Ranallo Nicoletta , Cantini Luca , Mariotti Lorenzo , Lucarelli Alessandra , Ballatore Zelmira , Berardi Rossana
Published: December 2020

Background: The spread of coronavirus disease brought the need to reorganize clinical activity in oncology. Cancer patients are very vulnerable, and it is well known that their treatment has to be strictly planned. The most critical considerations still relate to the entry of the virus into hospitals, the heart of health care, where cancer patients are protected. Instead, during the COVID19 pandemic the oncologic department had to limit access to care to protect patients from a more dangerous disease for them, witnessing a paradox of health care. This brought with it worries in oncologic health care professionals in replanning activities in order to guarantee therapeutic continuity and quality of care. It is well known that physicians and nurses have different role concepts and role expectations. The purpose of our study was to investigate doctors’ and nurses' perception of cancer patient reorganization during the COVID19 pandemic in a sample of Italian health care professionals in oncology.

Methods: We submitted a survey to oncologic health care workers (physicians and nurses) of Italian National Health Care System during the pandemic to investigate clinical activity reorganization and cancer patient management through 12 closed questions. The survey promoted by Clinica Oncologica, AOU Riuniti di Ancona-Università Politecnica delle Marche was electronic and anonymous.

Results: A total of 383 oncology health workers completed the survey, 60 nurses (15%) and 323 physicians (85%). 60% of interviewed physicians perceived qualitatively lower than usual the therapeutic path of patients taken in charge in this historical moment, while 45% of nurses declared it was the same (P<0.01). The continuity of the multidisciplinary team was defined as guaranteed for 68% of oncologists, while almost 40% of nurses declared to not know it. Almost all physicians (95%) answered that their clinical activity was reorganized, compared to a lower portion of nurses (80%) who replanned their care role (p<0.01). Deferring treatments caused fear and anxiety in 62% of physicians and 46% of nurses (P=0.027).

Conclusion: The survey underlined the need to integrate skills and involve all professional figures in planning cancer patients’ treatment to guarantee optimal therapeutic strategies and a global take in charge in all its details, even during emergencies.

Citation Format: Lucia Bastianelli, Filippo Merloni, Nicoletta Ranallo, Luca Cantini, Lorenzo Mariotti, Alessandra Lucarelli, Zelmira Ballatore, Rossana Berardi. Doctors and nurses during COVID19 pandemic: A different perception of cancer care [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-072.
Abstract S07-02: Patient-reported outcomes of breast cancer patients during the COVID-19 outbreak in the epicenter of China: A cross-sectional survey study
Authors: Li Juanjuan , Santa-Maria Cesar Augusto , Feng Hongfang , Wang Lingcheng , Zhang Pengcheng , Xu Yuangbing , Tan Yuyan , Liu Zhongchun , Du Bo , Lan Meng , Yang Qingfeng , Yao Feng , Tu Yi , Sun Shengrong , Li Xingrui , Chen Chuang
Published: December 2020

Purpose: We aimed to analyze the psychological status of breast cancer (BC) patients in the epicenter of the COVID-19 pandemic.

Patients and Methods: A total of 658 individuals were recruited from multiple breast cancer centers in Hubei Province. Online questionnaires were conducted and included demographic information, clinical features, and four patient-reported outcomes (PROs) scales (GAP-7, PHQ-9, ISI, and IES-R). Multivariable logistic regression analysis was designed to identify potential factors on mental health outcomes.

Results: Questionnaires were collected from February 16 to 19, 2020, the peak time point of COVID-19 outbreak in China. 46.2% of BC patients had to modify planned necessary anticancer treatment during the outbreak. 8.9% and 9.3% of patients reported severe anxiety and severe depression, respectively. 20.8% and 4.0% of patients showed severe distress and insomnia, respectively. Multivariable logistic regression analysis demonstrated poor general condition, shorter duration after BC diagnosis, aggressive BC molecular subtypes, and close contact with COVID-19 patients as independent factors associated with anxiety. Poor general condition and CVC (central venous catheter) flushing delay were factors independently associated with depression. In terms of insomnia, poor general condition was the only associated independent factor. Poor physical condition and treatment discontinuation were underlying risk factors for distress based on multivariable analysis.

Conclusion: High rates of anxiety, depression, distress, and insomnia were observed in patients with breast cancer during the COVID-19 outbreak. Special attention should be paid to the psychological status of breast cancer patients, especially those with poor general condition, treatment discontinuation, aggressive molecular subtypes, and metastatic breast cancer.

Citation Format: Juanjuan Li, Cesar Augusto Santa-Maria, Hongfang Feng, Lingcheng Wang, Pengcheng Zhang, Yuangbing Xu, Yuyan Tan, Zhongchun Liu, Bo Du, Meng Lan, Qingfeng Yang, Feng Yao, Yi Tu, Shengrong Sun, Xingrui Li, Chuang Chen. Patient-reported outcomes of breast cancer patients during the COVID-19 outbreak in the epicenter of China: A cross-sectional survey study [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S07-02.
Abstract S09-04: Unemployment and cancer screening: Baseline estimates to inform health care provision in the context of COVID-19 economic distress
Authors: Fedewa Stacey A. , Yabroff K. Robin , Zheng Zhiyuan , Bandi Priti , Sauer Ann Goding , Smith Robert A. , Nargis Nigar , Drope Jeffrey , Jemal Ahmedin
Published: December 2020

Introduction: During the COVID-19 pandemic, the unemployment rate has sharply risen from 3.5% in February 2020 to 13.3% in May 2020, a level not seen since the Great Depression. There are an estimated 21.0 million unemployed adults in the United States. Employers are the most common source of health insurance among working-aged adults and their families. Thus, job loss may lead to loss of insurance and reduce access to cancer screening, which can detect cancer at earlier, more treatable stages, and reduce cancer mortality. In this study, we examined sequential associations between unemployment, health insurance, and cancer screening to inform COVID’s potential longer-lasting impacts on early cancer detection.

Methods: Up-to-date (UTD) and recent (past-year) breast (BC) and colorectal cancer (CRC) screening prevalence were computed among respondents aged 50-64 years in 2000-2018 National Health Interview Survey data. Respondents were grouped as unemployed (not working but looking BC n=852; CRC n=1,747) and employed (currently working BC n=19,013; CRC n= 36,566). A series of logistic regression models with predicted marginal probabilities were used to estimate unemployed vs. employed unadjusted (PR) and adjusted prevalence ratios (aPR) and corresponding 95% Confidence Intervals (CI).

Results: Unemployed adults were four times as likely to be uninsured as employed adults (41.4% v 10.0%, p-value <0.001). Unemployment was associated with lower UTD breast (67.8% vs 77.5%, p-value<0.001, PR=0.82, 95%CI 0.77,0.87) and colorectal (49.4% and 60.1%, p-value<0.001, PR=0.86, 95%CI 0.80, 0.92) cancer screening prevalence. These differences remained after adjusting for race/ethnicity, age, and sex, but were eliminated after accounting for health insurance. Patterns and magnitudes of PR and aPRs were similar for past-year CRC and BC screening prevalence.

Conclusion: Unemployment was adversely associated with guideline-recommended and potentially life-saving breast and colorectal cancer screening. Compared to the employed, the unemployed disproportionately lacked health insurance, which accounted for their lower cancer screening utilization. Expanding and ensuring health insurance coverage after job loss may mitigate COVID-19’s economic impacts on cancer screening.

Citation Format: Stacey A. Fedewa, K. Robin Yabroff, Zhiyuan Zheng, Priti Bandi, Ann Goding Sauer, Robert A. Smith, Nigar Nargis, Jeffrey Drope, Ahmedin Jemal. Unemployment and cancer screening: Baseline estimates to inform health care provision in the context of COVID-19 economic distress [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S09-04.
Epigenetic Trajectories of the Premalignant-to-Malignant Transition of Chronic Lymphocytic Leukemia
Authors: Rossi Davide
Published: December 2020

Kretzmer and colleagues show that the transition to altered methylome occurs very early in chronic lymphocytic leukemia, and once acquired, it is a clonal and extremely stable change. However, the precise time point when the leukemic clone starts deviating significantly from the normal B-cell differentiation trajectory is still elusive.

See related article by Kretzmer et al., p. 54.
Abstract IA17: CAR T cells for T-cell lymphoma
Authors: Mamonkin Maksim
Published: December 2020

Development of CAR T-cell therapies for T-cell lymphoma has been hampered by a limited range of targetable antigens. Shared expression of most T-lineage antigens between malignant and normal T cells promotes fratricide of CAR T cells and increases the risk of T-cell aplasia. We developed a CAR targeting CD5, a pan-T cell antigen commonly expressed in T-cell lymphoma. CD5 CAR T cells evade fratricide by rapidly downregulating CD5 protein expression and retain high cytotoxicity against T-cell lymphoma. An ongoing phase I clinical trial demonstrates curative potential of autologous CD5 CAR T cells in patients with peripheral T-cell lymphoma. CD5 CAR T-cell infusions were well tolerated and did not produce prolonged ablation of endogenous T cells. Other CAR T cell-based approaches for T-cell lymphoma will also be discussed.

Citation Format: Maksim Mamonkin. CAR T cells for T-cell lymphoma [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr IA17.
Abstract IA23: The role of EZH2 gain-of-function mutations in lymphoma
Authors: Béguelin Wendy
Published: December 2020

Follicular lymphomas (FLs) are slow-growing, indolent tumors containing extensive follicular dendritic cell (FDC) networks and recurrent EZH2 gain-of-function mutations. Paradoxically, FLs originate from highly proliferative germinal center (GC) B cells with proliferation strictly dependent on interactions with T follicular helper cells. Herein, we show that EZH2 mutations initiate FL by attenuating GC B-cell requirement for T-cell help and driving slow expansion of GC centrocytes that become enmeshed with and dependent on FDCs. By impairing T-cell help, mutant EZH2 prevents induction of proliferative MYC programs. Thus, EZH2 mutation fosters malignant transformation by epigenetically reprograming B cells to form an aberrant immunologic niche that reflects characteristic features of human FLs, explaining how indolent tumors arise from GC B cells.

Citation Format: Wendy Béguelin. The role of EZH2 gain-of-function mutations in lymphoma [abstract]. In: Proceedings of the AACR Virtual Meeting: Advances in Malignant Lymphoma; 2020 Aug 17-19. Philadelphia (PA): AACR; Blood Cancer Discov 2020;1(3_Suppl):Abstract nr IA23.