Medical conditions such as diabetes and hypertension have been associated with an increased risk of severe illness secondary to COVID-19, but what role does breast cancer (BC) play in developing serious infection? Two studies, one from New York City and one from Paris, France, explored this issue.

The New York City study analyzed data from 27 patients with established stage I-IV BC (age range 32-87 years; median age 56 years) and COVID-19 who were treated at Columbia University Irving Medical Center between March 10 and April 29, 2020. The total number of patients with COVID-19 treated at this facility during this timeframe was 4,515. Of the 27 COVID-19 BC patients, 26 were female, 15 (56%) were white, six (22%) were black, and 12 (44%) were Hispanic; almost one-fifth had metastatic disease. 

Risk factors for severe COVID-19 disease were hypertension, diabetes, and pulmonary disease, with hypertension occurring in over one-half of the patients. All patients had received treatment for BC; the last treatment was administered from within the past day to 749 days prior to presenting with the viral infection. Almost 60% had received chemotherapy, with 44% receiving hormonal therapy and 22% receiving HER2-directed therapy; other treatment modalities included checkpoint inhibitors, surgery, and radiation therapy. Due to restrictive pandemic policies endorsed by healthcare facilities, almost three-quarters of BC patients in this study experienced an interruption of therapy. 

A diagnosis of COVID-19 was made based on a positive reverse transcription-polymerase chain reaction (RT-PCR) nasal swab in 81% of patients, and the rest of the patients diagnosed with COVID-19 based on clinical or radiographic findings. The most common presenting symptoms were cough, fever, shortness of breath, fatigue, diarrhea, and myalgia, with almost one-third having four or more symptoms. 

Over one-quarter (26%) required hospitalization and of these, three patients were Black, three were Hispanic, and one was white. Five of these patients had at least one comorbid disease, and three were former smokers. While most patients had received supplemental oxygen, none were admitted to the ICU. 

At Day 26, one death was observed—in the only male patient, an 87-year-old former smoker with stage II BC and underlying cardiovascular disease who had recently received taxane therapy. Further, these 27 patients accounted for only 0.6% of COVID-19 patients managed at this facility. The authors concluded that the findings, although based on limited data, were reassuring. 

In the French study, which was larger (76 patients), the main outcomes were death and ICU admission. In this observational study, which occurred between March 13, 2020 and April 25, 2020, the COVID-19 diagnosis was based on RT-PCR testing (41 patients), radiographic findings (18 patients), and/ or clinical presentation (17 patients). The authors distinguish the 59 confirmed  COVID-19 cases from the 17 symptomatic, unconfirmed cases throughout the paper. Common comorbidities in the former group included hypertension, obesity, diabetes, and heart disease; this breakdown was not provided for the latter group. 

Interestingly, the most common medication class utilized by the confirmed group was corticosteroids, with 22% of patients taking >20 mg equivalent dose of prednisolone for at least 1 month. Unlike the findings in New York, two-thirds of these patients had metastatic disease; all of the steroid users fell within this group. About one-half of documented COVID-19 patients were receiving chemotherapy and one-third were on endocrine therapy. The most common presenting symptoms in this group were fever and cough. 

Consistent with a diverse, multisystem disease, almost 90% of patients had <25% involvement of lung volume. Neither lung metastases nor prior radiation therapy influenced the severity of COVID-19. Almost one-half (47%) of the confirmed cases were hospitalized. Interestingly, while the United States was rushing to place COVID-19 patients on hydroxychloroquine, no patients in this French study were given the antimalarial medication. No patients with presumed COVID-19 infection required hospitalization. 

A follow-up analysis conducted 1 day before the conclusion of this study found that three-quarters of patients had recovered or were cured, 6.7% had died, and 17% were lost to follow-up. These investigators identified that age >70 years and hypertension were the two most important factors associated with severe disease. On a positive note, ongoing systemic treatments, lymphopenias, neutropenia, angiotensin-converting enzyme inhibitors, and angiotensin-receptor blockers were not associated with increased risk. Further, the authors were cautiously optimistic because this group of 76 patients represented only a small fraction of the 15,600 BC patients who were under care at Institut Curie hospitals. 

The results of these trials are encouraging and provide useful information about risk when pharmacists are responding to questions and concerns from their patients with BC. 

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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