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Toni K. Choueiri, MD, shares updates regarding the COVID-19 and Cancer Consortium and other changes he has experienced in clinical practice due to the ongoing COVID-19 pandemic.
Toni K. Choueiri, MD
The COVID-19 and Cancer Consortium (CCC19), a multicenter effort to obtain evidence-based information on patients with cancer who have tested positive for COVID-19, has now gained international members—making it a worldwide collaboration, explained Toni K. Choueiri, MD.
The CCC19 is designed for healthcare professionals to report patients whom they are treating for cancer and have also tested positive for COVID-19, in an effort to collect data and distribute information about this specific patient population.
“It's really been a pleasure all coming together in a comprehensive fashion, to start to ask these important questions,” said Choueiri, director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute and Jerome and Nancy Kohlberg Professor at Harvard Medical School, and who is also on the steering committee for CCC19.
The collaborative effort, which is made up of several leaders at various institutions, now has international members. Institutions based in the European Union, Argentina, Canada, and the United Kingdom are eligible to participate. Solange Peters, MD, PhD, of University Hospital Center Vaudois and Lausanne University in Switzerland, is also on the steering committee.
In an interview with OncLive, Choueiri, who is also the leader of the Kidney Cancer Program at Dana-Farber/Harvard Cancer Center, shared some of these updates regarding CCC19 and other changes he has experienced in clinical practice due to the ongoing COVID-19 pandemic.Choueiri: I'm on the steering committee of the CCC19 with many colleagues around the country, and now we are branching out even to Europe. We have Dr. Solange Peters, who is actually from Switzerland and is the current president of ESMO, and she is also on the CCC19 steering committee—making this a global collaboration. What we are trying to do is get first-hand information and real-world data on these patients who have COVID-19 and cancer at the same time—not just for patient actively receiving therapy, but also for patients with a prior history of cancer.
While there are prospective clinical trials that are ongoing with COVID-19, things are changing very fast. We believe that in order to fully understand this pandemic, we need to capture data on both symptomatic and asymptomatic patients who are heavily affected by this disease, and we need to be nimble and fast. Therefore, the CCC19, which involves many National Cancer Institute—designated cancer centers, is growing by the day. We have almost daily emails and phone calls with all of the steering committee members. As we said, we're branching out to have a partnership with ESMO, and hopefully we start working on a manuscript and publication that should come soon.
It puts us all together, because we need to understand what impact COVID-19 has on our patients with cancer and how it's affecting our practice. At Dana-Farber Cancer Institute, we moved a lot of our patients to virtual visits, whether we are doing face-to-face using a Zoom-type form, or [over the phone]. We still have face-to-face patient encounters, but this is changing. We are at the frontlines of this pandemic, and we need to understand, from an oncological perspective, what's happening with our patients. Hopefully, this is an attempt to understand and dig more. The fact that it is national with many centers, and now European centers, will make us hopefully, understand this pandemic and learn from best practices.We are actually entering data as we speak. We have hundreds of cases, but there are many variables for each case. We have people working on entering the data actively; it includes anything from a past history of medication, comorbidities, and other [factors that] are all entered, along with cancer type and stage.
On the steering committee, we also have scientist and patient advocate, Corrie A. Painter, PhD, who has joined us. She's a scientist from Broad Institute of MIT and Harvard, and she herself is a cancer survivor. We have Dr. Solange Peters, from Switzerland, and Gary Lyman, MD, MPH, FASCO, FRCP, from [University of Washington]. There is also leadership from Jeremy Warner, MD, MS, FAMIA, FASCO, and Brian Rini, MD, of Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center. I cannot count everyone [who is involved].
If people are interested, they can visit www.ccc19.org; it gives you tips about who we are, frequently asked questions, the collaborators, the publication, and actually it is a resource that is updated every day about COVID-19 and who also is doing similar initiatives. There are other initiatives for patients who do not have cancer. There are initiatives also led by ASH; some initiatives are being done in the United Kingdom, from TERAVOLT, from the COVID-19 Global Rheumatology Alliance, and from the SECURE- Cirrhosis Registry [among others].Absolutely. I can't keep up sometimes with emails, but it's a group effort with amazing collaborators, and we are putting the patients at the center of everything. Hopefully this is behind us at some point, and then we can go back to our routine lives—although our routine lives are going to be interesting post—COVID-19.You click on the survey, and it asks you if you intend to make a report on a patient who has a presumptive- or lab-proven COVID-19. If you say, "Yes," it will ask you if the patient has been entered in other registries or if this is the first one. It will ask you if you're reporting on behalf of an institution participating in that Consortium, and if you say "Yes," you enter the institution. Then, you submit. By that time, it takes you to a unique patient number, and you fill out the age and gender [and other information]. Of course, we have to have Institutional Review Board (IRB) approval, which we obtained in a very record time—in less than 10 days. Our leadership and IRB leadership are also in tune with how important this is to disseminate the information.It is amazing how much our institution shifted. We are working and we're taking care of patients, whether over the phone, virtually, or sometimes in person. Our doors are open to help patients at Dana-Farber Cancer Institute; we have to work in real time. What changed is the communication. We always had great communication, but now it's a hyper-communication; all of the time we are talking. We agree, we go back and forth, re-examine, and re-examine [again] because things change. It's not us. It's the virus that is dictating what we do every day and every hour.
Therefore, things change from having 1 visitor to no visitors, to patients themselves having a mask on. We change every day even with who gets tested among patients and among healthcare professionals. It's going very well; it tells you that in a situation of hardship like this, nothing is better than communicating all the time—and having an open line of communication with all of the stakeholders.I looked at one of my favorite social media platforms, Twitter, and there [was a tweet] about over 260 trials ongoing at this time with COVID-19. Many are interventional, so things are going very fast. However, you have to be careful and take yourself out of it and say, "What are we looking at? Are we looking at a study like [CCC19 is] doing, which is an observational study, or retrospective study, or are we looking at interventional studies with medication?"
If it is with medication, we have to understand that, if a patient has a positive test but they don't have a lot of symptoms, they may be eligible for [one type of] trial. However, if a patient is in the intensive care unit, and they have hypoxia or are intubated, then there is another type of a clinical trial. We do have clinical trials in Massachusetts for [these types of patients], and we have scientists at Dana-Farber Cancer Institute who are tackling this problem. If there is a clinical trial, mostly for patients who test positive, they should look at the closest site [to them] and call their physician. There isn't 1 drug that's proven to prevent this disease, but hopefully we get some answers pretty soon.