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

Perrine Vuagnat, Maxime Frelaut, Toulsie Ramtohul, Clémence Basse, Sarah Diakite, Aurélien Noret, Audrey Bellesoeur, Vincent Servois, Delphine Hequet, Enora Laas, Youlia Kirova, Luc Cabel, Jean-Yves Pierga, Institut Curie Breast Cancer and COVID Group, Laurence Bozec, Xavier Paoletti, Paul Cottu, François-Clément Bidard, Aurélia Alimi, Muriel Belotti, Okba Bensaoula, Ophélie Bertrand, Geoffroy Bilger, Etienne Brain, Hervé Brisse, Bruno Buecher, Laetitia Chanas, Caroline Chapus, Isabelle Charles-Massar, Pascal Chérel, Gilles Créhange, Christelle Colas, Hélène Delhomelle, Thomas Frederic-Moreau, Emmanuelle Fourme, Pierre Fumoleau, Marion Gauthier-Villars, Olivier Lantz, Sophie Lassalle, Marine Le Mentec, Florence Lerebours, Delphine Loirat, Matthieu Minsat, Pauline Moreau, Antoine de Pauw, Maël Priour, Fabien Reyal, Roman Rouzier, Mary Saad, Claire Saule, Clara Sebbag, Dominique Stoppa-Lyonnet, Anne Tardivon, Silvia Takanen, Dominique Vanjak, Marie-Charlotte Villy, Anne Vincent-Salomon, Mathilde Warcoin, Perrine Vuagnat, Maxime Frelaut, Toulsie Ramtohul, Clémence Basse, Sarah Diakite, Aurélien Noret, Audrey Bellesoeur, Vincent Servois, Delphine Hequet, Enora Laas, Youlia Kirova, Luc Cabel, Jean-Yves Pierga, Institut Curie Breast Cancer and COVID Group, Laurence Bozec, Xavier Paoletti, Paul Cottu, François-Clément Bidard, Aurélia Alimi, Muriel Belotti, Okba Bensaoula, Ophélie Bertrand, Geoffroy Bilger, Etienne Brain, Hervé Brisse, Bruno Buecher, Laetitia Chanas, Caroline Chapus, Isabelle Charles-Massar, Pascal Chérel, Gilles Créhange, Christelle Colas, Hélène Delhomelle, Thomas Frederic-Moreau, Emmanuelle Fourme, Pierre Fumoleau, Marion Gauthier-Villars, Olivier Lantz, Sophie Lassalle, Marine Le Mentec, Florence Lerebours, Delphine Loirat, Matthieu Minsat, Pauline Moreau, Antoine de Pauw, Maël Priour, Fabien Reyal, Roman Rouzier, Mary Saad, Claire Saule, Clara Sebbag, Dominique Stoppa-Lyonnet, Anne Tardivon, Silvia Takanen, Dominique Vanjak, Marie-Charlotte Villy, Anne Vincent-Salomon, Mathilde Warcoin

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.

Keywords: Breast cancer; COVID-19; Outcome; SARS-CoV-2; Survival.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient flow and COVID-19 testing. a Patient flow. b Relationship between clinical, laboratory, and radiologic features. Venn diagram focusing on the 30 patients with symptoms and available CT scan and RNA test results. Independence of RNA test and CT scan was rejected (Fisher’s exact test, p < 0.001)
Fig. 2
Fig. 2
COVID-19 patients’ trajectory. Follow-up consisted in clinical evaluation by phone calls scheduled at days 8, 14, and 28

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