publication date: Mar. 4, 2020

Coronavirus vs. oncology: Meeting cancellations, travel restrictions, fears about drug supply chain

By Alexandria Carolan

NOTE: An earlier version of this story was published March 4 on the web and was updated March 6 to include information about restricted travel for employees of cancer centers, meeting cancellations, potential disruptions to the drug supply chain, and funds allocated by U.S. Congress for combatting the coronavirus.

This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage, as well as the latest meeting cancellations, is available here.

 

Forecasts of the inevitable spread of coronavirus can be difficult to ignore, especially at a time when many of us are making travel plans for this spring’s big cancer meetings.

The decision was made all the more difficult earlier this week, as cancer centers and at least one biotechnology company—Amgen—implemented travel bans that are expected to last through the end of March and beyond. The Cancer Letter was able to confirm such travel bans at Fred Hutchinson Cancer Research Center, MD Anderson Cancer Center, and Dana-Farber Cancer Institute.

Fred Hutch, located in Seattle, in the state where at this writing 13 patients have died of the coronavirus, also instituted a mandatory work from home policy for everyone but “essential, on-campus staff such as wet lab staff, security and facilities management.”

On March 5, after learning about the travel restrictions, the American Association for Cancer Research said it’s evaluating “all available options for the meeting, including virtual presentations or postponing the meeting to a later date.”

The American Society of Clinical Oncology announced March 6 that it is “actively planning alternative scenarios, should they be needed.” 

The National Comprehensive Cancer Network March 5 postponed its 2020 annual conference of about 1,500 attendees March 19-22 in Orlando, citing precautions against coronavirus.

“The health and safety of our attendees and the patients they take care of is our number one concern,” said Robert W. Carlson, chief executive officer of NCCN. “This was an incredibly difficult and disappointing decision to have to make. However, our conference attendees work to save the lives of immunocompromised people every day. Some of them are cancer survivors themselves, particularly at our patient advocacy pavilion. It’s our responsibility, in an abundance of caution, to safeguard them from any potential exposure to COVID-19.”

The loss of the NCCN meeting could cost the organization millions of dollars, Carlson said to The Cancer Letter.

“The NCCN made the decision to postpone the NCCN Annual Conference independent of financial ramifications. It was just the right thing to do,” Carlson said. “Worst case, the dollar cost to NCCN could be in the millions of dollars, hopefully the reality will be much less. Either way, NCCN is financially sound and has adequate reserves to cover the loss.”

In lieu of an annual conference, NCCN is considering supplementing the annual conference with webinars and future in-person educational sessions and meetings. “While both of these issues are frustrating and unanticipated, the safety and welfare of the attendees at our conferences and events and their patients is our primary concern and goal,” Carlson said.

Other cancellations of meetings in oncology and related fields include:

  • Flatiron Health postponed its March 10-12 research summit in Washington, D.C. “While this was a very difficult decision, we know that the health of our partners and employees is most important,” a spokesperson said to The Cancer Letter.

  • Healthcare Information and Management Systems Society, a health-technology conference with about 45,000 in attendance in Orlando, cancelled its March 9-13 conference. President Donald Trump was slated to speak at the meeting.

  • The First International Summit on Interventional Pharmacoeconomics decided to postpone the meeting that was scheduled to take place in Tel Aviv March 25-27. “We cancelled the meeting as a number of participants were unable to attend due to restrictions on travel put in place by their employers, as well as the potential risk of a quarantine of American travelers by the Israel Ministry of Health, as reported in the Jerusalem Post,” said Mark Ratain, the meeting’s co-chair and the Leon O. Jacobson Professor of Medicine and director of the Center for Personalized Therapeutics at the University of Chicago. Israel has since prohibited international conferences.

  • The International Papillomavirus Conference in Barcelona March 23-27. 

The Cancer Letter is maintaining an up-to-date list here, along with all additional coverage.

Reports of cancellation or postponement of major conferences outside oncology add to the sense of uncertainty.

Casualties include:

  • The London Book Fair, set to take place March 10-12, cancelled its meeting that generally has about 25,000 attendees.

  • MWC Barcelona, formerly the World Mobile Conference, which would have brought more than 100,000 people to Barcelona in February.

  • The Denver meeting of the American Physical Society, with attendance of 20,000, was also cancelled.

  • Facebook, Intel, and Twitter have pulled out of the massive South by Southwest (SXSW) conference March 13-22, which usually brings more than 100,000 people to Austin.

 

Travel restrictions

Fred Hutch announced a mandatory remote work policy that will stay in effect until March 31.

“No Fred Hutch employees have been diagnosed with the virus as of today, but out of an abundance of caution, the organization accelerated its preparedness plans, recognizing proximity to health care operations and patients,” the policy states.

Fred Hutch has also banned work-related domestic and international travel from March 5 through March 31. The institution stipulates that Fred Hutch employees who are away on business should return back to the country.

Dana-Farber Cancer Institute and MD Anderson Cancer Center have instituted work-related travel bans to prevent spread of the virus. 

Dana-Farber’s policy states: 

  • All Dana-Farber-related business travel is suspended until further notice.

  • All business-related visits to Dana-Farber from CDC-defined impacted areas continue to be suspended.

  • Additionally, we encourage all workforce members to consider restricting their personal travel during this time.

Staff and faculty at MD Anderson are restricted in business travel, domestic and international, through April 29—which coincides with AACR’s meeting in late April.

MD Anderson’s policy states:

  • We will monitor closely and re-evaluate whether an extension is needed or whether travel restrictions can be lifted when there is clear evidence that the global public health emergency is abated according to MD Anderson’s website.

“It is obviously a serious situation and we’re monitoring it very closely. Hospital leaders are meeting daily about coronavirus to prepare and plan,” Ellen Berlin, director of Media Relations at Dana-Farber, said to The Cancer Letter. “While we recognize this is a significant inconvenience, our priority remains the  health and safety of our workforce, and the health and safety of our patients.”

The biotech company Amgen has also prohibited international business travel for its staff until March 21.

 

Oncology meetings set to happen

The Cancer Letter asked ASCO, AACR, Community Oncology Alliance, European Society for Medical Oncology, and Association of American Cancer Institutes to discuss their plans for the 2020 annual meetings and describe the processes that would be used to make these decisions.

The responses follow:

AACR, April 24-29, San Diego

“The AACR is monitoring daily the continuing developments pertaining to the novel coronavirus—including tracking travel restrictions issued by the U.S. Government, following guidance from the CDC and WHO, and talking with our peer organizations. We want to assure colleagues planning to attend any upcoming AACR national or international meetings that safety and security are our top priorities.

“We were recently made aware that several stakeholders, including cancer centers, academic institutions, and pharmaceutical companies, are considering or have instituted temporary travel restrictions that, if unchanged, would prevent their employees from attending or presenting at the Annual Meeting. These stakeholders have indicated that their travel restrictions are subject to review and may be lifted if circumstances change. To gather more information, we have reached out to the leadership of key U.S. and international stakeholders to confirm their policies regarding staff travel. We will continue to monitor the status of any new or existing travel restriction policies as the situation evolves.

“At this time, we are still planning to hold the Annual Meeting in San Diego, April 24-29. The theme of this year’s meeting is ‘Turning Science into Lifesaving Care.’ We realize that the cancer research community highly values the vital information, new data, and exchange of ideas and collaborations that ensue from this meeting. Therefore, in the event that circumstances do not improve, we are exploring all available options for the meeting, including virtual presentations or postponing the meeting to a later date. We will continue to engage with our stakeholders and monitor new developments in this fluid situation so that we can make the best possible evidence-based decision.

“We will provide further updates as events warrant. Colleagues who have questions can contact the AACR by email at meetings@aacr.org or by phone at 215-440-9300 (international callers dial +1-215-440-9300).”

ASCO, May 29-June 2, Chicago

“ASCO continues to monitor the novel coronavirus (COVID-19) and is committed to a safe and productive 2020 annual meeting experience.

“The health and safety of attendees and exhibitors remains the society’s top priority. At this time, we are planning to hold the meeting in Chicago as scheduled. 

“However, because the situation and public health guidance are changing rapidly, we are actively planning alternative scenarios, should they be needed. ASCO is committed to fulfilling its mission of disseminating critical cancer research—one way or another, we look forward to providing a rich meeting and learning experience for the global oncology community May 29-June 2. [We are] working with exhibitors and registered attendees to evaluate options for those unable to attend due to travel restrictions.”

COA, April 23-24, Orlando

“The Community Oncology Alliance  is working closely to plan for a safe and successful 2020 Community Oncology Conference in Orlando.

“With more than two months to go before the 2020 conference, we want to ensure that our response is based on facts, not fear. It is important to remember CDC has deemed the health risk of the coronavirus for the general American public to be low at this time, and the city of Orlando is continuing to host successful events daily.

“COA is currently planning to proceed with the 2020 conference as planned. We are currently seeing a record-setting registration compared to last year, are almost completely sold out of hotel rooms and the exhibit hall, and are experiencing no unusual cancellations.”

ESMO, Sept. 18-22, Madrid

“At present ESMO is not planning to cancel or postpone scheduled meetings. Please visit the webpage of each individual meeting you are interested in and check the homepage for regular updates.

“ESMO is constantly checking the measures and directives released by those countries where meetings are planned. To facilitate access to educational material for those who should be prevented from travelling, cannot leave their countries or prefer not to take particular risks, ESMO will provide live and/or recorded webcasts from events via esmo.org.

“For the safety of attendees, according to information and guidance provided by the WHO, ESMO is actively taking all the recommended measures to offer a safe environment at meetings, including temperature control stations at the entrance of the congress venue, hand sanitizers available for attendees, medical staff onsite to assist participants.

“We also recommend anyone planning to attend to follow the WHO recommendations for protecting themselves and others from the infection. We feel it is our responsibility to remind all when making travel decisions that it would be prudent to consider the importance of your own health and the well-being of others. 

“This is especially valid if you are a medical professional seeing patients regularly, feeling unwell with fever or respiratory symptoms, coming from a high-risk area or been in or near any of the hot zones in the previous days.

AACI/CCAF, Oct. 11-13, Kansas City

“The health and well-being of AACI’s meeting attendees and their patients is our top priority. We are closely monitoring the progress of the coronavirus and its potential impact on AACI members.”

At this writing, more than 200 people in the U.S. have contracted the coronavirus and 14 have died (The New York Times). As the virus spreads, the CDC said cancellation of large gatherings would be on the table.

CDC’s initial response to the spread includes offering testing for the coronavirus, “SARS-CoV-2,” or COVID-19 in five cities: Los Angeles, San Francisco, Seattle, Chicago, and New York City. The AACR and ASCO annual meetings would take place in San Diego and Chicago respectively—in states where cases have been documented.

The first community-transmitted cases of the disease in the country were detected late February in California, Oregon, and Washington—another was confirmed in New York state. Upwards of 60 cases were confirmed in California—some through community-contact rather than by travelling abroad. Five cases of the virus were confirmed in Illinois.

CDC has also issued travel advisories, warning against visiting all countries with Level 3—nonessential travel—notices.

The fact that this list includes China likely constitutes a setback for the oncology annual meetings. At ASCO, for example, China accounts for the largest foreign contingent of conference-goers, followed by Japan, which has been given a Level 2 notice—recommending against nonessential travel for older adults and those with chronic medical conditions.

In 2019, international attendees accounted for 14,800 of the 42,500 registrants of the ASCO annual meeting. Attendees from China made up 1,471 of registrants. Attendees from Japan followed just behind China, at 1,336.

Nearly a third of those who attend the AACR annual meeting are from outside the U.S. Information on how many attendees travel from China and Japan was not immediately available.

Travelers who have recently visited the Hubei province in China are subject to mandatory quarantine upon return to the U.S. Those who visited China, not just the Hubei province, are asked to self-quarantine themselves for two weeks. Additionally, foreign nationals who visited China within the past 14 days are not allowed to enter the U.S.

The loss of annual meetings for AACR and ASCO, or even the loss of attendance, would mean oncology professionals would miss out on the opportunity to catch up on the year’s cutting-edge research in oncology. Ultimately, patients could be prevented from receiving the most up-to-date care.

 

Registration deadlines

Early registration for ASCO began in November, and for AACR in December. Registration for AACI’s joint annual meeting with the Cancer Center Administrators Forum hasn’t begun.

About 42,000 oncology professionals and exhibitors attended ASCO in 2019, and about 22,000 attended AACR.

“ASCO has dedicated resources to support the oncology community’s participation, regardless of exigent circumstances,” the society said in a statement.

Here is how ASCO plans to address the virus as of right now:

  • Following guidance and recommended safety measures of CDC and the World Health Organization.

  • Working with the City of Chicago, McCormick Place Convention Center, airport authority, and area hotels to coordinate appropriate safety procedures.

  • Adhering to CDC recommendations and protocols for heightened levels of cleanliness at the Convention Center, including adding hand sanitizer stations.

  • Providing resources to address immediate health concerns.

  • Working with exhibitors and registered attendees to evaluate options for those unable to attend due to travel restrictions.”

This is not the first time an outbreak of a coronavirus has cancelled oncology meetings.

Such was the case for AACR in 2003, when the professional society cancelled its then $7 million annual meeting in Toronto because of the SARS-CoV outbreak. The decision was made  two days before the meeting was to begin (The Cancer Letter, April 4, 2003). In a controversial move, NCI, acting without peer review, provided AACR with $2 million to assist paying for the postponed meeting in 2003 (The Cancer Letter, June 20, 2003).

In 2018, the most recent year with publicly available financial information for ASCO, education fees and meeting registration accounted for nearly $43 million of the total $170 million in revenue that year. Registration and education fees are the biggest category of revenue for the society, though this includes its smaller symposia—gastrointestinal, genitourinary, and immuno-oncology as well.

Advertising and exhibits made up about $38 million of ASCO’s revenue in 2018.

AACR’s scientific meetings and educational workshops added up to nearly $26 million of its total $112 million revenue in 2018. That number is eclipsed only by contributions, which accounted for nearly $59 million of AACR’s total revenues.

Attendees of these meetings pay upwards of $500 for registration alone at either of these meetings, depending on their member status with the organization. And if the conferences end up being postponed or cancelled because of the virus—it’s up to the individual attendee to absorb the cost of travel and accomodations, or rely on the good will of airlines and hotels.

AACR’s charges include a $125 processing fee for cancelling registration, according to the website. No refunds can be made after March 20, the society says on its website. The cost of cancellation for ASCO is $75, and these funds will be processed after the meeting, according to ASCO. Cancellations must be made by May 26.

 

U.S. government response

On Feb. 26, President Donald Trump placed Vice President Mike Pence in charge of the U.S. response to the virus. Pence, a former governor of Indiana, was previously criticized for failing to respond quickly to an HIV outbreak among drug users in the state.

At the time, health officials had urged Pence to allow the distribution of clean drug needles in the state—a policy Pence wavered on for two months until he issued an executive order on the matter, and consequently slowed the incidence of HIV in the state.

NIH officials have been silenced by the White House, Rep. John Garamendi (D-CA) said in a report: “[Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases] said, ‘I was not muzzled. However, I was to go on the Sunday talk shows five of them. The vice president’s office then took over the control of this situation, and told me to stand down, not to do those shows,’” Garamendi said, quoting Fauci.

In a Feb. 28 interview with Politico, Fauci said, “You don’t want to go to war with a president, but you got to walk the fine balance of making sure you continue to tell the truth.

“I don’t think that we are going to get out of this completely unscathed,” Fauci said. “I think that this is going to be one of those things we look back on and say boy, that was bad.”

Coronavirus testing in the U.S. has been scarce and initially ineffective, The New York Times reported. Trump has also been accused of spreading disinformation after he said the coronavirus is a “hoax” perpetuated by Democrats.

Later, he clarified his statement to say the “hoax” referred to criticisms of his administration’s response.

The first batch of tests in the U.S. were faulty, and it took weeks for CDC to send replacements. Vice President Pence said there are likely not enough tests in the U.S. to meet demand.

“We don’t have enough tests today to meet what we anticipate will be the demand going forward,” Pence told reporters March 5.

Quest Diagnostics announced that coronavirus testing will be available at its facilities beginning March 9.

CDC updated its guidelines March 4 to allow testing with a doctor’s approval. Before this, those concerned they had the virus were required to check the boxes of strict criteria to receive testing.

The CDC, and HHS Secretary Alex Azar have faced backlash over a lack of coordinated response to the disease in the U.S. At a congressional committee hearing, Azar declined to confirm that a coronavirus vaccine—if developed—would be affordable to all Americans.

“We would want to ensure that we work to make it affordable, but we can’t control that price, because we need the private sector to invest,” Azar said.

Azar’s statement and the U.S. government response stands in contrast to other countries, where tests are widely accessible and affordable. In the U.S., CDC said March 4 that it has tested 1,526 patients—which does not include testing at state and public laboratories that began this week.

FDA issued a policy Feb. 29 to speed up the availability of diagnostic tests.

“We believe this policy strikes the right balance during this public health emergency,” FDA Commissioner Stephen M. Hahn, said in a statement. “We will continue to help to ensure sound science prior to clinical testing and follow-up with the critical independent review from the FDA, while quickly expanding testing capabilities in the U.S. We are not changing our standards for issuing Emergency Use Authorizations.”

Hahn said FDA and CDC are working with a private company to ensure that a million tests are available by the end of the first week of March.

“Our expectation in talking to the company that is scaling this up is that we should have the capacity by the end of the week to have kits available to the laboratories to perform about a million tests,” Hahn said at a Senate hearing March 3.

In other countries, response to the virus has been more robust. Since the virus was first detected in Wuhan, China, millions of residents have been successfully tested. In South Korea, officials have made the test for the virus free for residents and non-residents, and there are drive-through centers for patients to be tested without even leaving their cars.

The U.S. government hasn’t yet announced a fix to the current testing problem. Trump declared March 3 that he is considering using a national disaster program to pay hospitals and health care workers for care of those infected with coronavirus.

 

Drug supply chain disruptions

FDA expects that the coronavirus will cause disruptions in the drug supply chain, stating that drug shortages are possible.

“A manufacturer has alerted us to a shortage of a human drug that was recently added to the drug shortages list,” Hahn said in a statement. “The manufacturer just notified us that this shortage is related to a site affected by coronavirus. The shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug.”

Drug manufacturers are required to notify FDA of any supply issues that lead to a meaningful disruption of a covered drug in the U.S.

“PhRMA and our member companies are closely monitoring the coronavirus and the situation in China and as the situation evolves, our companies are working proactively to prevent and mitigate additional potential shortages through close coordination with the FDA and other global stakeholders,” a spokesperson from Pharmaceutical Research and Manufacturers of America said to The Cancer Letter.

The Leukemia and Lymphoma Society highlighted the potential disruption of Imbruvica (ibrutinib), manufactured in China.

“Some cancer patients may be worried about the supply of their treatments that come from China,” Gwen Nichols, chief medical officer of LLS, wrote in a March blog. “However, [Imbruvica’s] manufacturer Pharmacyclics said that they are monitoring the situation closely and at this time do not expect any impact on their product supply. As of now, no other manufacturers have stated that this outbreak will have an impact on supply. We are in close touch with manufacturers and will post an update if this changes.”

Amgen has said it doesn’t anticipate drug shortages in its supplies, but cannot rule out impact on sales, manufacturing, and clinical trials.

“Based on inventory levels, we do not anticipate a shortage of our medicines due to COVID-19 at this time. We are monitoring our raw material inventory levels and taking additional measures to mitigate against interruption,” the company said in a statement.

 

More from the government

WHO has warned governments across the globe: This is not a drill.

The virus is present in 80 countries and territories. More than 100,000 infections have been confirmed globally, and more than 3,300 people have died from COVID-19.

“This is not a drill. This is not the time to give up. This is not a time for excuses. This is a time for pulling out all the stops. Countries have been planning for scenarios like this for decades. Now is the time to act on those plans,” WHO Director Tedros Adhanom Ghebreyesus said March 6. “This epidemic can be pushed back, but only with a collective, coordinated and comprehensive approach that engages the entire machinery of government.”

President Trump signed a $8.3 billion spending bill March 6 for coronavirus containment and development of vaccines. Trump initially requested $2.5 billion to combat the virus.

CDC will receive $2.2 billion for the outbreak, and $3 billion will go toward development of a vaccine and and treatment. One billion dollars will fund the state department in humanitarian assistance.

At a hearing of the House Committee on Appropriations March 5, Anthony Fauci, director of the NIAID, said CDC and FDA are going to begin proactive testing of the coronavirus in the five cities that had initial testing—Seattle, Los Angeles, San Francisco, New York, and Chicago—plus Honolulu. 

“We’re beginning to do it now. It was not implemented earlier,” Fauci said. “There aren’t enough resources to do it in every single emergency room in every single center.”

CDC and FDA are expanding proactive testing to more cities, Fauci said, “essentially, doing sentinel surveillance in different places. That will give us a good idea, or at least a partially good idea, on what’s under the radar—screening that we’re missing.”

Fauci said NIH is about six weeks out from a phase I trial—“Which, as a matter of fact will be the fastest that anyone has gone from the identification of a sequence of a phase I trial in any vaccine that’s ever been done—that’s the good news.”

Fauci estimates the phase I trial will take two to four months with about 45 individuals. If that’s successful, the phase II trial will enroll hundreds or thousands of patients. It would be a year to 1.5 years after that until the vaccine is ready for the public, Fauci said.

“The reality of vaccinology means that this is not something that we’re going to have tomorrow,” he said.

 

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This story was updated March 9, 2:55 P.M. EST

Copyright (c) 2020 The Cancer Letter Inc.