Journal Article

COVID-19 lockdown-related treatment modifications did not impact the outcome of digestive cancers: the Clin-COVIDICA prospective study

Elfadel, Rayan, Guyot d’Asnières de Salins, Astrid, Ferru, Aurélie, Evrard, Camille, Ingrand, Isabelle, Randrian, Violaine, Pillet, Armelle, Boyer, Claire, Rouleau, Laetitia, Dhimene, Amale, Tougeron, David

2025

Overview

Background The Coronavirus Disease 2019 (COVID-19) pandemic modified the organization of cancer care pathways worldwide. Few prospective long-term data assessing these therapeutic modifications are available. Methods Clin-COVIDICA was a prospective cohort aiming at determining the clinical impact of COVID-19-related therapeutic modifications in patients with digestive cancer in our center. All consecutive patients undergoing an oncologic treatment for a digestive cancer from March 1 to April 30, 2020, were enrolled in the cohort and followed-up for 24 months. The primary endpoint was progression-free survival (PFS). Secondary endpoints included COVID-19 rate, adverse events (AE) and overall survival (OS). Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test. Results Of the 401 patients included, 39.6% were female, mean age was 68 years old and most frequent tumor were colorectal (50.0%) and pancreatic (17.9%) cancers. All in all, 55 patients (13.7%) have undergone therapeutic modifications. The most frequent were a switch to an oral drug (capecitabine, 30.9%), treatment holidays (29.1%) and treatment cancellation (18.2%). Considering patients with palliative treatment ( n  = 339), there was a non-significant trend for longer OS (52.0 months versus 36.4 months, p  = 0.07) and a significant longer PFS (15.4 months versus 6.2 months, p  = 0.009) in patients with therapeutic modifications. There were more all grades AEs in patients without therapeutic modifications (84.4% vs. 65.5%, p = < 0.001), but more severe AEs (grade 3–5) among patients with therapeutic modifications (18.2% versus 8.7%, p  = 0.048), especially for patients with a switch to an oral drug, which resulted in 8 severe adverse events and one death. Six patients (1.5%) had a COVID-19, with one COVID-19-related death and one definitive cancellation of a curative surgery due to the consequences of COVID-19. Discussion We observed no negative survival impact of therapeutic modifications due to the COVID-19 pandemic in digestive cancer management. This may be due to the selection of patients with less aggressive disease. More severe AEs were observed upon therapeutic modifications, especially switching to oral capecitabine. Trial registration Clinicaltrials.gov: NCT04389684; date of registration (15/05/2020).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Adverse events / Aged / Aged, 80 and over / Biomedical and Life Sciences / Biomedicine / Cancer / Cancer patients / Cancer Research / Cancer therapies / Capecitabine / Cardiovascular disease / Care and treatment / Chemotherapy / Colorectal cancer / Control / Coronary vessels / Coronaviruses / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 - virology / Diabetes / Diagnosis / Digestive system cancer / Digestive System Neoplasms - drug therapy / Digestive System Neoplasms - mortality / Digestive System Neoplasms - therapy / Disease management / Disease transmission / Epidemics / Evidence-based medicine / Female / Health aspects / Health Promotion and Disease Prevention / Humans / Male / Medical prognosis / Medicine/Public Health / Metastasis / Middle Aged / Oncology / Oncology, Experimental / Oral administration / Pandemics / Patients / Prospective Studies / Shelter in place / Surgery / Surgical Oncology / Survival / Treatment toxicity / Vein & artery diseases