15 COVID-19 Disease Course in Immunocompetent and Immunocompromised Patients in a Breast Cancer Registry

The demographics, comorbidities, menopausal status, endocrine therapy, breast cancer morphology, and treatment history of 45 patients with non–stage IV breast cancer and COVID-19 were analyzed. Immune status at COVID-19 diagnosis, COVID-19 disease severity and treatment, complete blood count (CBC) with differentials at and within 2 weeks of COVID-19 diagnosis, hospital/intensive care unit admission, and mortality were explored in relation to the influence of SARS-CoV-2 on the mononuclear phagocyte system (via M1/M2 macrophages) and the multimodal influences of menopause, estrogen, immunomodulatory drugs, and endocrine therapy on the immune system as well as gene expression of ACE2, NRP1, and TMPRSS2. Within each ethnicity group, percentages by number of comorbidities and body mass index ranges were correlated with disease severity and mortality. In the second analysis, COVID-19 outcomes were then examined, taking note of menopausal status, endocrine therapy, and receptor positivity. Hispanic individuals had a similar percentage of obese patients as African Americans, the highest percentage of class III obesity (16.67%), and the highest percentage of severe COVID-19 disease (10.57%). Recent studies report reliable laboratory markers such as neutrophil-to-lymphocyte ratio in a COVID-19 hematocytometric index for severity and mortality. No appreciable changes in CBC differentials were noted due to limited serial CBCs. All immunocompetent patients with breast cancer hospitalized for hypoxia or acute hypoxic respiratory failure had a mild COVID-19 disease course and the vast majority displayed eosinopenia; aromatase inhibitors were the known form of endocrine therapy in usage. There was a significantly greater number of postmenopausal patients infected irrespective of immune status. Recording of periodic CBC differentials, immunomodulatory drugs, endocrine therapy, and menopausal status can determine priority groups of care for non–stage IV breast cancer during the COVID-19 pandemic. Further investigation of the protective roles of selective estrogen receptor modulators and other forms of endocrine therapy against SARS-CoV-2 is warranted.