One hundred and thirty organizations, cancer centers, and other institutions sent a letter to President Joe Biden and his administration, as well as other leading public health officials at state health departments to underscore the need to provide patients with cancer and survivors of cancer with priority access to a coronavirus disease 2019 (COVID-19) vaccine, according to a press release issued by the American Association for Cancer Research (AACR).

“We fully support your COVID-19 vaccination plan that calls for broadening access and vaccinating as many Americans as rapidly as possible,” the letter states. “However, we are compelled to underscore the urgency of prioritizing access to a COVID-19 vaccine for patients with active cancer and survivors of cancer.”

Patients with cancer are at high risk of severe illness and death from COVID-19, and due to the need for frequent in-person care while receiving treatment, they could be at increased risk for exposure to the virus, as well.

 Additionally, survivors of cancer have a higher probability of infection and death from the virus compared with the general population.

Results from a retrospective case-control analysis published in the 

Journal of the American Medical Association

, patients with cancer who are diagnosed with COVID-19 are more likely to require hospitalization (47.46%) than those without cancer who have been diagnosed with COVID-19 (24.26%).

 Additionally, according to an article published by the AACR COVID-19 and Cancer Task Force, COVID-19 fatality rates for patients with cancer were double that of those without cancer.

“Many Americans are delaying regular doctor appointments that could lead to a diagnosis of cancer, meaning that we are likely to see a higher number of patients diagnosed when their cancers are at a more advanced stage,” the letter says. “Without the protection offered by a vaccine, these patients are not only at risk of being infected with COVID-19, but a COVID-19 diagnosis could also severely impact their available treatment options.”

The Centers for Disease Control and Prevention (CDC) has recognized that patients with cancer are at higher risk for severe COVID-19 infection,

 although many states are broadening and simplifying the groups eligible for vaccination to speed up distribution.

“It seems like the states just opened things up completely, and next thing you know, we opened the floodgates to everyone being eligible to get the vaccine,” Jon Retzlaff, the chief policy officer for AACR, told 

. “In a time of limited supply, this is very problematic for these high-risk patients who really needed to get the vaccine. As such, it has really become an issue of extreme importance to the entire cancer care community.”

Moreover, the letter notes that while widespread, rapid vaccination is a worthy goal, the currently limited supply of vaccines means that many who are at high risk for severe illness and death from the virus, may continue to wait for many months if they are not provided with priority access.

Earlier this year, the COVID-19 Vaccine Committee of the National Comprehensive Cancer Network released published guidance, which also recommended that patients with active cancer, or with active, recent, or planned cancer treatment, as well as their care givers, be considered highest priority to receive a COVID-19 vaccine.

“We sincerely hope that you and your colleagues in the administration will stress to all State Public Health Departments that patients with active cancer and survivors of cancer must be provided priority access to a lifesaving COVID-19 vaccine,” the letter closes.

130 organizations, cancer centers, and other institutions send letter to Biden urging priority access to a COVID-19 vaccine for cancer patients and survivors. February 17, 2021. Accessed February 18, 2021. 

Letter to President Biden and leaders of state public heath departments: prioritizing COVID-19 vaccines for patients with cancer and survivors of cancer. American Association for Cancer Research. February 17, 2021. Accessed February 18, 2021. 

Wang Q, Berger NA, Xu R. Analysis of risk, racial disparity, and outcomes among US patients with cancer and COVID-19 infection. 

. 2021;7(2):220-227. doi:10.1001/jamaoncol.2020.6178

Ribas A, Sengupta R, Locke T, et al. Priority COVID-19 vaccination for patients with cancer while vaccine supply is limited. 

. 2021;11(2):233-236. doi:10.1158/2159-8290.CD-20-1817

People with certain medical conditions. Centers for Disease Control and Prevention. Accessed February 18, 2021. 

CDC’s COVID-19 vaccine rollout recommendations. Centers for Disease Control and Prevention. Accessed February 18, 2021. 


This article was originally published on OncLive as, "

130 Centers, Organizations Call for Priority Access to a COVID-19 Vaccine for Patients With Cancer."

Articles

Leading organizations, cancer centers, and other institutions sent a letter to President Joe Biden and his administration, as well as other leading public health officials at state health departments advocating for priority access to the COVID-19 vaccine for patients and survivors of cancer.

Prioritize Patients With Cancer for COVID-19 Vaccine, Orgs Say

Reductions in prostate-specific antigen (PSA) screening are likely responsible for the recent increase in metastatic prostate cancer cases in the United States, according to epidemiologic data from a study presented during the 2021 Genitourinary Cancers Symposium.

“To reduce the incidence of metastatic prostate cancer in the United States, we support policies that promote shared decision making to optimize PSA screening, such as the updated United States Preventive Services Task Force [USPSTF] guidelines,” presenting study author Vidit Sharma, MD, a chief resident in the Department of Urology at Mayo Clinic, said during a poster presentation of the data.

PSA screening was found to reduce metastases and mortality in patients with prostate cancer, according to results from the randomized ERSPC trial. However, screening has also been known to result in significant harms from overdiagnosis and overtreatment of low-risk prostate cancer, Sharma noted. As a result, the USPSTGF found insufficient evidence to recommend PSA screening in 2008 and went on to recommend against it in 2012.

“Several subsequent studies have found that there has been a rise in prostate cancer diagnosis since that change,” Sharma said. “Although the implication of these studies is that decreases in PSA screening were responsible for the rise in metastases, this has not been directly demonstrated.”

The objective of this study was to test the hypothesis that reductions in PSA screening were responsible for increased incidence of metastatic prostate cancer at diagnosis. To do this, investigators examined statewide variation in PSA screening, as well as statewide variation in the incidence of metastatic disease at diagnosis from 2002 to 2016.

Investigators extracted age-adjusted incidence of metastatic prostate cancer diagnosis per 100,000 men from the North American Association of Central Cancer Registries for each state. Additionally, survey-weighted PSA screening estimates for men 40 years of age or older were extracted from the Behavioral Risk Factor Surveillance System, which collected data on PSA screening every 2 years from 2002 onward.

These data were then analyzed in a multi-panel time series by state, using a random effects linear regression model, which looked at random effect at the state level, as well as related changes in PSA screening to incidence of prostate cancer metastases within and between states.

Results showed a significant variation in the incidence of PSA screening between states in men aged 40 years or older (range, 40.1%-70.3%). However, after 2010, a significant decrease in the median percentage of PSA screening across all states (range, 61.8%-50.5%) was observed. Additionally, investigators also noted a significant variation in the incidence of age-adjusted metastatic prostate cancer at diagnosis by state (range, 3.3 to 14.3 per 100,000 men) until 2010, when median incidence increased across all states.

Investigators found that states with larger decreases in PSA screening, there was a larger increase in the incidence of metastatic prostate cancer at diagnosis. Data from the random effects linear regression model confirmed that reductions in PSA screening were related to rises in metastatic disease at diagnosis (-14.9; 95% CI, 12.3-17.5 per 100,000; 

“Overall, variation in PSA screening explained 27% of variation in metastatic disease at diagnosis,” Sharma concluded.

Vidit Sharma, Abhishek Venkataramana, et al. Association of reductions in PSA screening across states with increased metastatic prostate cancer in the United States

. 2021;39(suppl 6):228. doi:10.1200/JCO.2021.39.6_suppl.228

This article was originally published on OncLive as, "

Reduction in PSA Screening Associated with Increased Incidence of Metastatic Prostate Cancer in the United States

Reductions in prostate-specific antigen screening are likely responsible for the recent increase in metastatic prostate cancer cases in the United States.

Metastatic Prostate Cancer Rates Rise as PSA Screening Decreases

A shorter course of stereotactic body radiotherapy (SBRT) has been shown to have encouraging efficacy with favorable toxicity when used in patients with high-risk prostate cancer in a multi-institutional, international setting, according to findings from a study published in the 

International Journal of Radiation Oncology, Biology, Physics

Led by investigators at the University of California, Los Angeles (UCLA) Jonsson Comprehensive Cancer Center, the study found that SBRT, which delivers higher doses of radiation therapy over the course of 5 or fewer treatments, is safe and as effective as the standard 45-day course of radiation therapy in this patient population.

 However, further prospective studies are needed to determine the optimal dose and target volume of SBRT in these patients.

“These findings suggest that SBRT, which condenses radiation treatment for prostate cancer into as few as 4-5 sessions (as compared with 20-45 sessions previously), is safe and effective in a broad setting for patients with high-risk prostate cancer,” lead study author Amar U. Kishan, MD, an assistant professor of radiation oncology at the David Geffen School of Medicine at UCLA and researcher at the UCLA Jonsson Comprehensive Cancer Center, told 

. “This has previously been shown in patients with low- and intermediate-risk prostate cancer but extending these findings to [those with] high-risk prostate cancer broadens applicability [of this approach].”

SBRT can be considered for patients with high-risk prostate cancer, as long as they have social or medical hardships that prevent longer courses of radiation therapy, according to 2020 National Comprehensive Cancer Network guidelines. However, guidelines issued by the European Association of Urology are less supportive of this. 

The latter note that the major evidence to support ultra-hypofractionation for this patient population is based on data yielded from a subset of 126 patients who were enrolled to the randomized phase 3 HYPO-RT-PC trial (ISRCTN45905321). Participants did not receive concurrent androgen deprivation therapy (ADT), which is now considered a standard of care for patients with high-risk disease receiving definitive radiotherapy. The authors of that trial concluded that their general conclusions of oncologic equivalency may not be applicable to patients with high-risk prostate cancer. Other published prospective data supporting SBRT for this patient population are limited.

Earlier research led by investigators at UCLA provided significant evidence that a shortened regimen of radiation therapy could be a feasible treatment option for patients with low- and intermediate-risk prostate cancer.

 Investigators decided to broaden this study to see whether a shorter treatment course of radiation could be used in patients with more aggressive disease.

For this research, investigators collected patient-level data from 7 institutions with phase 2 studies and prospective databases. Data were pooled for a total of 344 patients with a minimum follow-up of 24 months. Biochemical recurrence-free survival (BCRFS) and distant metastasis-free survival (DMFS) were estimated using a Kaplan-Meier framework, while Fine and Gray competing risk and Cox proportional hazards regression models were created to evaluate the association between time to biochemical recurrence (BCR) and time to distant metastasis and prespecified variables of interest. Logistic regression models were developed to evaluate associations between acute and late grade 2 or higher genitourinary and gastrointestinal and a priori determined variables, like age, dose per fraction, ADT use, and nodal radiotherapy.

The median follow-up on the study was 49.5 months (range, 35.8-61.9). Seventy-two percent of patients (n = 248) received ADT, with a median duration of 9 months. Results showed that the estimated BCRFS and DMFS rates at 4 years were 81.7% (95% CI, 77.2%-86.5%) and 89.1% (95% CI, 85.3%-93.1%), respectively. Seventeen percent of patients (n = 59) had a BCR and 8% (n = 26) experienced distant metastases.

Multivariable competing risk analyses revealed that 7 Grey (Gy) per fraction versus 8 Gy per fraction was significantly linked with increased risk of BCR (subdistribution HR [sHR], 2.15; 95% CI, 1.07-4.32; P = .03), as was natural log initial prostate-specific antigen (sHR, 1.42; 95% CI, 1.0-1.08; P = .02). Additionally, investigators did not observe any significant predictors of time to distant metastases.

Cause-specific models showed comparable results with regard to BCR and distant metastases. Here, a 1-year increase in age at treatment was found to be significantly linked with increased BCR risk (HR, 1.04; 95% CI, 1-1.07; P = .035).

BCRFS was found to be significantly greater in the patients who received ADT (log-rank P = .009), although no significant difference was observed with DMFS (log-rank P = .097). The cumulative incidence of BCR was observed to be substantially lower in the patients who received ADT (P value, .017 per Gray’s test), while the cumulative incidence of distant metastases was not different (P value, 0.36 per Gray’s test). 

Regarding safety, acute grade 2 or greater genitourinary (GU) toxicity was reported in 18% of patients, while 5% of patients experienced gastrointestinal (GI) effects. No acute grade 3 or higher GU or GI effects were observed. Notably, a dose per fraction of 7 Gy was linked with lower odds of acute grade 2 or higher GU toxicity, while a dose per fraction of 8 Gy was associated with higher odds of this toxicity (odds ratio [OR], 0.09; 95% CI, 0.02-0.48; P = .005).

The 4-year cumulative incidence estimate for late grade 2 or higher GU toxicity was 17.6% (95% CI, 13.6%-21.9%), while this estimate was 6.4% (95% CI, 3.7%-10.1%) for GI toxicity.

Moreover, the crude incidences of late grade 3 or higher GU toxicity was 2.3% versus 0.9% for GI toxicity, with a median time to onset of 21 months and 22 months, respectively.

Although the results of this study highlight the efficacy of this approach, and overall toxicity rates were low and consistent with prior data with SBRT in patients with low- and intermediate-risk disease, the study still had limitations. For one, this analysis focused on multiple single- arm phase 2 studies and prospective registries. Due to the non-randomized nature of the study, this research cannot provide level I evidence to support SBRT for use in this patient population. 

The ongoing randomized PACE-C trial is expected to provide additional level 1 evidence concerning the efficacy of SBRT vs conventional radiotherapy among patients with HRPCa.

“There are several intriguing avenues [for future exploration]. First and foremost, large randomized trials, such as PACE-C run out of the United Kingdom, will be critical to cement SBRT as the standard option, as opposed to a standard option, so we eagerly await that,” Kishan told OncLive. “Second, multiple ongoing studies are [being done] to find out how we can best optimize treatment in patients with more aggressive features, perhaps by adding drugs or selectively increasing the dose, and de-escalating treatments in patients with less aggressive features. Third, technological advances, such as direct magnetic resonance imaging—guided radiotherapy, may help us improve the precision of this treatment further and [this is] being actively studied.”

1. van Dams R, Jiang NY, Fuller, DB, et al. Stereotactic body radiotherapy for high-risk localized CARcinoma of the prostate (SHARP) consortium: analysis of 344 prospectively treated patients. Int J Radiat Oncol Biol Phys. Published online January 22, 2021. doi:10.1016/j.ijrobp.2021.01.016

2. Study finds shorter radiation regimen safe, effective for men with advanced prostate cancer. News release. UCLA Health. January 25, 2021. Accessed January 26, 2021. http://bit.ly/3cfs4MM.

A shorter course of stereotactic body radiotherapy (SBRT) has been shown to have encouraging efficacy with favorable toxicity when used in patients with high-risk prostate cancer in a multi-institutional, international setting, according to findings from a study published in the International Journal of Radiation Oncology, Biology, Physics.

Courtney Marabella

Articles

Prioritize Patients With Cancer for COVID-19 Vaccine, Orgs Say

Metastatic Prostate Cancer Rates Rise as PSA Screening Decreases

Shorter SBRT Treatment Is Safe, Efficacious in High-Risk Prostate Cancer