Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Sep 1;4(9):e2124483.
doi: 10.1001/jamanetworkopen.2021.24483.

Association of COVID-19 Lockdown With the Tumor Burden in Patients With Newly Diagnosed Metastatic Colorectal Cancer

Alain R Thierry  1 , Brice Pastor  1 , Ekaterina Pisareva  1 , Francois Ghiringhelli  2 , Olivier Bouché  3 , Christelle De La Fouchardière  4 , Julie Vanbockstael  5 , Denis Smith  6 , Eric François  7 , Mélanie Dos Santos  8 , Damien Botsen  9 , Stephen Ellis  10 , Marianne Fonck  11 , Thierry André  12 , Emmanuel Guardiola  13 , Faiza Khemissa  14 , Benjamin Linot  15 , J Martin-Babau  16 , Yves Rinaldi  17 , Eric Assenat  18 , Lea Clavel  19 , Sophie Dominguez  20 , Celine Gavoille  21 , David Sefrioui  22 , Veronica Pezzella  23 , Caroline Mollevi  1 , Marc Ychou  1 , Thibault Mazard  1
Affiliations
Multicenter Study

Association of COVID-19 Lockdown With the Tumor Burden in Patients With Newly Diagnosed Metastatic Colorectal Cancer

Alain R Thierry et al. JAMA Netw Open. .

Abstract

Importance: The COVID-19 pandemic has been associated with substantial reduction in screening, case identification, and hospital referrals among patients with cancer. However, no study has quantitatively examined the implications of this correlation for cancer patient management.

Objective: To evaluate the association of the COVID-19 pandemic lockdown with the tumor burden of patients who were diagnosed with metastatic colorectal cancer (mCRC) before vs after lockdown.

Design, setting, and participants: This cohort study analyzed participants in the screening procedure of the PANIRINOX (Phase II Randomized Study Comparing FOLFIRINOX + Panitumumab vs FOLFOX + Panitumumab in Metastatic Colorectal Cancer Patients Stratified by RAS Status from Circulating DNA Analysis) phase 2 randomized clinical trial. These newly diagnosed patients received care at 1 of 18 different clinical centers in France and were recruited before or after the lockdown was enacted in France in the spring of 2020. Patients underwent a blood-sampling screening procedure to identify their RAS and BRAF tumor status.

Exposures: mCRC.

Main outcomes and measures: Circulating tumor DNA (ctDNA) analysis was used to identify RAS and BRAF status. Tumor burden was evaluated by the total plasma ctDNA concentration. The median ctDNA concentration was compared in patients who underwent screening before (November 11, 2019, to March 9, 2020) vs after (May 14 to September 3, 2020) lockdown and in patients who were included from the start of the PANIRINOX study.

Results: A total of 80 patients were included, of whom 40 underwent screening before and 40 others underwent screening after the first COVID-19 lockdown in France. These patients included 48 men (60.0%) and 32 women (40.0%) and had a median (range) age of 62 (37-77) years. The median ctDNA concentration was statistically higher in patients who were newly diagnosed after lockdown compared with those who were diagnosed before lockdown (119.2 ng/mL vs 17.3 ng/mL; P < .001). Patients with mCRC and high ctDNA concentration had lower median survival compared with those with lower concentration (14.7 [95% CI, 8.8-18.0] months vs 20.0 [95% CI, 14.1-32.0] months). This finding points to the potential adverse consequences of the COVID-19 pandemic and related lockdown.

Conclusions and relevance: This cohort study found that tumor burden differed between patients who received an mCRC diagnosis before vs after the first COVID-19 lockdown in France. The findings of this study suggest that CRC is a major area for intervention to minimize pandemic-associated delays in screening, diagnosis, and treatment.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bouché reported receiving personal fees from Amgen, Roche, Merck, Bayer, and Servier outside the submitted work. Dr De La Fouchardière reported receiving personal fees from Servier, Amgen, Bayer, Eisai, Ipsen, Lilly, Merck, MSD, Pierre Fabre, and Roche as well as nonfinancial support (travel for American Society of Clinical Oncology and European Society for Medical Oncology meetings) from Amgen, Roche, Sanofi-Aventis, and Servier. Dr Botsen reported receiving personal fees from Amgen, Chugai Pharmaceutical Co Ltd, Pierre Fabre, Sanofi, and Fresenius Kabi outside the submitted work. Dr André reported receiving personal fees from Amgen, Astra Zeneca, Astellas Pharma Inc, Bristol Myers Squibb, MSD, Gritstone Oncology, GlaxoSmithKline, Servier, Pierre Fabre, Roche, Ventana, Halliox, and Kaleido Biosciences outside the submitted work. Dr Khemissa reported receiving other (Congress fees) from Roche, Servier, Ipsen, and Fresenius Kabi as well as personal fees from Sanofi and Bayer outside the submitted work. Dr Sefrioui reported receiving personal fees from Ipsen, Roche, Servier, and Bayer outside the submitted work. Dr Thierry reported being a shareholder of DiaDx SAS. Dr Mazard reported receiving grants from Amgen SAS; nonfinancial support from Servier and MSD; and personal fees from Merck Serono, Bristol Myers Squibb, Sanofi Genzyme, AAA, Sandoz, and Bayer outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Comparison of Circulating Tumor DNA (ctDNA) Concentration in Patients With Newly Diagnosed Metastatic Colorectal Cancer in the Prelockdown and Postlockdown Periods
The long horizontal bars indicate the median; shorter bars, the 95% CIs; and each dot, the ctDNA concentration in a single patient. The Mann-Whitney test was performed to compare the patient distributions and revealed a significant difference between the prelockdown and postlockdown periods.
Figure 2.
Figure 2.. Comparison of Patients at the Start of the PANIRINOX Study and the Prelockdown Period
The box plot represents circulating tumor DNA (ctDNA) concentration in patients in the 110-day fractional cohorts vs patients in the prelockdown (n = 40) and postlockdown (n = 40) periods. The Mann-Whitney test was performed to compare patient distributions. The horizontal bars inside the boxes indicate the median; error bars, the 10th to 90th percentile; squares, the median between the 25% percentile and the 75% percentile; whiskers, the 10th to 90th percentile; and each dot, the ctDNA concentration of a single patient outside the 10th to 90th percentile.
Figure 3.
Figure 3.. Overall Survival Analysis of Patients With Newly Diagnosed Metastatic Colorectal Cancer (mCRC)
ctDNA indicates circulating tumor DNA.
See this image and copyright information in PMC

References

    1. Richards M, Anderson M, Carter P, Ebert BL, Mossialos E. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020;1(6):1-3. doi:10.1038/s43018-020-0074-y - DOI - PMC - PubMed
    1. Uzzo RG, Kutinov A, Geynisman DM. COVID-19: cancer screening, diagnosis, post-treatment surveillance in uninfected patients during the pandemic and issues related to COVID-19 vaccination in cancer patients. Accessed October 9, 2020. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-canc...
    1. Greenwood E, Swanton C. Consequences of COVID-19 for cancer care—a CRUK perspective. Nat Rev Clin Oncol. 2021;18(1):3-4. doi:10.1038/s41571-020-00446-0 - DOI - PMC - PubMed
    1. De Vincentiis L, Carr RA, Mariani MP, Ferrara G. Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018-2019: an audit study from cellular pathology. J Clin Pathol. 2021;74(3):187-189. doi:10.1136/jclinpath-2020-206833 - DOI - PubMed
    1. Kaufman HW, Chen Z, Niles J, Fesko Y. Changes in the number of US patients with newly identified cancer before and during the coronavirus disease 2019 (COVID-19) pandemic. JAMA Netw Open. 2020;3(8):e2017267. doi:10.1001/jamanetworkopen.2020.17267 - DOI - PMC - PubMed

Publication types

MeSH terms