Impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in patients with soft tissue sarcoma: an analysis from the OnCovid registry

Bruno Vincenzi; Alessio Cortellini; Alessandro Mazzocca; Sarah Orlando; Davide Romandini; Juan Aguilar-Company; Isabel Ruiz-Camps; Claudia Valverde Morales; Simeon Eremiev-Eremiev; Carlo Tondini; Joan Brunet; Rossella Bertulli; Salvatore Provenzano; Mark Bower; Daniele Generali; Ramon Salazar; Anna Sureda; Aleix Prat; Michalarea Vasiliki; Mieke Van Hemelrijck; Ailsa Sita-Lumsden; Alexia Bertuzzi; Sabrina Rossi; Amanda Jackson; Federica Grosso; Alvin J X Lee; Cian Murphy; Katherine Belessiotis; Uma Mukherjee; Fanny Pommeret; Angela Loizidou; Gianluca Gaidano; Gino M Dettorre; Salvatore Grisanti; Marco Tucci; Claudia A M Fulgenzi; Alessandra Gennari; Andrea Napolitano; David J Pinato

doi:10.1177/17588359231225028

Impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in patients with soft tissue sarcoma: an analysis from the OnCovid registry

Ther Adv Med Oncol. 2024 Jan 18:16:17588359231225028. doi: 10.1177/17588359231225028. eCollection 2024.

Authors

Bruno Vincenzi^{1

2}, Alessio Cortellini^{1

3}, Alessandro Mazzocca^{1

2}, Sarah Orlando^{1

2}, Davide Romandini^{1

2}, Juan Aguilar-Company^{4

5}, Isabel Ruiz-Camps^{4

5}, Claudia Valverde Morales⁶, Simeon Eremiev-Eremiev^{4

5}, Carlo Tondini⁷, Joan Brunet⁸, Rossella Bertulli⁹, Salvatore Provenzano⁹, Mark Bower¹⁰, Daniele Generali^{11

12}, Ramon Salazar¹³, Anna Sureda¹⁴, Aleix Prat^{15

16}, Michalarea Vasiliki¹⁷, Mieke Van Hemelrijck^{17

18}, Ailsa Sita-Lumsden¹⁷, Alexia Bertuzzi¹⁹, Sabrina Rossi¹⁹, Amanda Jackson²⁰, Federica Grosso²¹, Alvin J X Lee²², Cian Murphy²², Katherine Belessiotis²², Uma Mukherjee²³, Fanny Pommeret²⁴, Angela Loizidou²⁵, Gianluca Gaidano²⁶, Gino M Dettorre²⁷, Salvatore Grisanti²⁸, Marco Tucci^{29

30}, Claudia A M Fulgenzi^{2

31}, Alessandra Gennari³², Andrea Napolitano³³, David J Pinato^{31

32}

Affiliations

¹ Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
² Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
³ Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, Du Cane Road, London, UK.
⁴ Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain.
⁵ Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain.
⁶ Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain.
⁷ Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
⁸ Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain.
⁹ Medical Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
¹⁰ Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK.
¹¹ Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Italy.
¹² Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
¹³ Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain.
¹⁴ Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
¹⁵ Department of Medical Oncology, Hospital Clinic, Barcelona, Spain.
¹⁶ Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain.
¹⁷ Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK.
¹⁸ Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
¹⁹ Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
²⁰ Velindre Cancer Centre, Cardiff, UK.
²¹ Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
²² Cancer Division, University College London Hospital, London, UK.
²³ Medical Oncology, Barts Health NHS Trust, London, UK.
²⁴ Department of Cancer Medicine, Institut Gustave Roussy, University of Paris Saclay, Villejuif, France.
²⁵ Department of Infectious Diseases, Internal Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
²⁶ Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Ospedale Maggiore della Carità Hospital, Novara, Italy.
²⁷ Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
²⁸ Medical Oncology Unit, Spedali Civili, Brescia, Italy.
²⁹ Section of Medical Oncology, Department of Interdisciplinary Medicine (DIM), University of Bari 'Aldo Moro', Bari, Italy.
³⁰ IRCCS, Istituto Tumori Giovanni Paolo II, Bari, Italy.
³¹ Department of Surgery and Cancer, Imperial College of London, Hammersmith Hospital Campus, London, UK.
³² Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
³³ The Royal Marsden NHS Foundation Trust, London, UK.

Abstract

Background: To date, limited evidence exists on the impact of COVID-19 in patients with soft tissue sarcoma (STS), nor about the impact of SARS-CoV-2 vaccines and recent chemotherapy on COVID-19 morbidity and mortality in this specific population.

Methods: We described COVID-19 morbidity and mortality among patients with STS across 'Omicron' (15 December 2021-31 January 2022), 'Pre-vaccination' (27 February 2020-30 November 2020), and 'Alpha-Delta' phase (01 December 2020-14 December 2021) using OnCovid registry participants (NCT04393974). Case fatality rate at 28 days (CFR₂₈) and COVID-19 severity were also described according to the SARS-CoV-2 vaccination status, while the impact of the receipt of cytotoxic chemotherapy within 4 weeks prior to COVID-19 on clinical outcomes was assessed with Inverse Probability of Treatment Weighting (IPTW) models adjusted for possible confounders.

Results: Out of 3820 patients, 97 patients with STS were included. The median age at COVID-19 diagnosis was 56 years (range: 18-92), with 65 patients (67%) aged < 65 years and most patients had a low comorbidity burden (65, 67.0%). The most frequent primary tumor sites were the abdomen (56.7%) and the gynecological tract (12.4%). In total, 36 (37.1%) patients were on cytotoxic chemotherapy within 4 weeks prior to COVID-19. The overall CFR₂₈ was 25.8%, with 38% oxygen therapy requirement, 34% rate of complications, and 32.3% of hospitalizations due to COVID-19. CFR₂₈ (29.5%, 21.4%, and 12.5%) and all indicators of COVID-19 severity demonstrated a trend toward a numerical improvement across the pandemic phases. Similarly, vaccinated patients demonstrated numerically improved CFR₂₈ (16.7% versus 27.7%) and COVID-19 morbidity compared with unvaccinated patients. Patients who were on chemotherapy experienced comparable CFR₂₈ (19.4% versus 26.0%, p = 0.4803), hospitalizations (50.0% versus 44.4%, p = 0.6883), complication rates (30.6% versus 34.0%, p = 0.7381), and oxygen therapy requirement (28.1% versus 40.0%, p = 0.2755) compared to those who were not on anticancer therapy at COVID-19, findings further confirmed by the IPTW-fitted multivariable analysis.

Conclusion: In this study, we demonstrate an improvement in COVID-19 outcomes in patients with STS over time. Recent exposure to chemotherapy does not impact COVID-19 morbidity and mortality and SARS-CoV-2 vaccination confers protection against adverse outcomes from COVID-19 in this patient population.

Keywords: COVID-19; SARS-CoV-2; chemotherapy; pandemic; sarcoma; soft tissue sarcoma; vaccines.

Plain language summary

An analysis from the OnCovid registry on the impact of chemotherapy and SARS-CoV-2 vaccines on clinical outcomes of patients with soft tissue sarcoma and COVID-19 Soft tissue sarcomas (STS) are a group of rare and aggressive tumours, usually treated with high dose cytotoxic chemotherapy. To date no clear evidence exists on the impact of COVID-19 in patients with STS, nor on the potential impact of recent chemotherapy and prior SARS-CoV-2 vaccination in this specific patient population. This is the 1st study to show COVID-19 outcomes in patients with STS, highlighting a substantial vaccine efficacy with no negative impact of recent chemotherapy on COVID-19 outcomes.

Grants and funding

WT_/Wellcome Trust/United Kingdom