In a Q&A, Dr. Larissa Korde of the National Cancer Institute explains what the study hopes to achieve and how the pandemic has affected existing cancer treatment and research.
Dr. Larissa Korde, MD
Head — Breast Cancer and Melanoma Therapeutics at the National Cancer Institute
Can you tell us a little bit about this new study?
The NCI COVID-19 in Cancer Patients Study (NCCAPS) is designed to better understand the effects of COVID-19 infections on cancer patients. We will assess COVID-19 symptoms, disease severity, and imaging findings in patients who are receiving active treatment for cancer and are infected with SARS-CoV-2, the novel coronavirus that causes COVID-19. We are also collecting research blood specimens so that we can gain an understanding of the specific effects of COVID-19 on cancer patients. We plan to look at markers of the body’s immune response to the virus, abnormalities in blood clotting, and at the development and persistence of antibodies.
How does COVID-19 affect people with cancer?
While not a lot is known yet about how COVID-19 affects cancer patients, preliminary data from studies in China, Europe, and here in the United States, suggest that people with cancer may be more at risk for severe COVID-19. Cancer patients receive a wide variety of treatments (such as chemotherapy or radiation) that can weaken the immune system. Cancer itself, particularly at more advanced stages, can also result in a weakened immune system. We also know that infections of all types can cause delays in cancer treatment. That’s why we believe it is especially important to understand the effects of COVID-19 on cancer patients, and we think this study will help us to do that. The study will enroll up to 2000 patients who will be followed for two years so that we can understand both the short term and long-term effects of the virus on people with cancer.
Can you walk us through some of the risk factors related to serious illness from COVID-19 in people undergoing treatment for cancer?
While we are just starting to learn about this from other studies, the information we have suggests that patients on active treatment, and those with metastatic cancer (cancer that has already spread) are at high risk of serious illness. It’s important to note that some risk factors for severe COVID-19 infection, such as smoking, older age, and obesity, also place people at higher risk for developing certain types of cancer. We also know that COVID-19 disproportionately affects minority and underserved populations and communities of color, and we really want to be able to understand the effects of COVID-19 in cancer patients in these communities.
Does treatment type affect a cancer patient’s specific response to COVID-19?
We are hoping that our study will provide important information to answer this question. We know that different cancer treatments have varying effects on the immune system, both immediately and in the long term. For example, a bone marrow transplant can have profound and life-long effects on the immune system. There is a new class of cancer treatments that actually work by augmenting the body’s immune response to cancer, and we are very interested to see the effects of these drugs on the course of COVID-19 illness.
Are there additional precautions a cancer patient should take with regard to COVID-19 that differs from that of the general public?
This is something that each patient should discuss with their doctor, because the answer will depend on the type and stage of cancer and the type of treatment the patient is receiving. We know that patients who are receiving active treatment for cancer often need to go to the clinic for their treatments, and so it’s definitely important for patients to wear masks and to practice social distancing as much as possible. Patients can also speak to their individual health care teams about whether some follow-up appointments can be done via telemedicine.
What does this study hope to establish?
We really hope that this and other studies will help us to better understand which cancer patients are most at risk for severe COVID-19 disease and will also give us important information about the long-term effects of COVID-19 infection. By collecting clinical information, blood samples, and imaging studies, we hope to learn more about how and why COVID-19 causes serious illness in some patients but not in others. We will also study how COVID-19 affects cancer treatment and the results of the treatment. The blood sample collections are aimed at finding genetic risk factors and markers of serious illness. Finally, this study will create a bank of data, blood samples, and images from people with COVID-19 and cancer for future research.
How does one enroll in this study and who are the prime candidates?
The study is recruiting patients who are undergoing active treatment for cancer and have a positive test for SARS-CoV-2, the novel coronavirus that causes COVID-19 within the last 14 days. We are currently only enrolling adult patients, but plan to expand the study to include children with COVID-19 and cancer in the near future. The study is now open at more than 700 sites across the United States, including large cancer centers and community oncology practices. Cancer patients interested in learning more about the study can go to https://www.cancer.gov/research/key-initiatives/covid-19/coronavirus-research-initiatives/nccaps.
How do you see COVID-19 changing the future of cancer?
The pandemic has definitely affected how we deliver medical care in general. For cancer patients in particular, it will be really important to sort out what can safely be done with telehealth visits instead of in-person visits.