1714P Change of circulating pro-inflammatory markers between pre-COVID-19 condition and COVID-19 diagnosis predicts early death in cancer patients: The FLARE score

Background: Inflammation plays a central role in severe COVID-19 disease Likewise, in cancer patients (pts), a circulating pro-inflammatory status (proinflam-status) is associated with poor outcomes We aimed to assess if a proinflam-status induced by cancer can negatively impact on COVID-19 outcomes Methods: Multicenter retrospective cohort of cancer pts with SARS-CoV-2 infection across 12 international centers Circulating inflammatory markers were collected at two timepoints: pre-COVID condition (-15 to -45d before COVID-19 diagnosis) and COVID-19 diagnosis Tumor-induced proinflam-status was defined by high derived neutrophil to lymphocyte ratio (dNLR>3) at pre-COVID condition COVID-induced proinflam-status was defined by +100% increase of dNLR between both timepoints We built the FLARE score, combining both Tumor and Infection-induced inflammation: T+/I+ (poor), if both proinflam-status;T+/I- (T-only), if inflammation only due to tumor;T-/I+ (I-only), if inflammation only due to COVID;and T-/I- (favorable), if no inflam-status Primary endpoint was 30-day mortality Results: 287 pts were enrolled with a median follow-up of 23d [95%CI 22-26] Median age was 69 (range 35-98), 52% were male and 49% had hypertension As per cancer characteristics: 68% had active disease, 52% advanced stage and 79% had a baseline PS≤1 Thoracic cancers were the most common (26%) and 61% of pts were under systemic therapy The dNLR was high in 24% at pre-COVID condition vs 55% at COVID-19 diagnosis Median change between both timepoints was +67% (IQR: 0% to +153%);40% had +100% increase of dNLR Pts distribution across FLARE groups were: 5% in poor (n=9), 20% in T-only (n=39), 35% in I-only (n=69) and 40% in favorable (n=80) Overall mortality rate was 27% According to FLARE score: 67% mortality for poor vs 35% for I-only vs 33% for T-only vs 19% in favorable group (p=0 008) The FLARE poor group was independently associated with 30-day mortality [OR 5 7;1 02-31 2] Conclusions: Both tumor and infection-induced proinflam-status impact on COVID-19 outcomes in cancer pts The FLARE score, based on simple dynamics between two timepoints, allows to identify the population at higher risk for early death Legal entity responsible for the study: Aleix Prat Funding: Has not received any funding Disclosure: E Auclin: Travel/Accommodation/Expenses: Mundipharma;Speaker Bureau/Expert testimony: Sanofi Genzymes S Pilotto: Speaker Bureau/Expert testimony: AstraZeneca;Eli-Lilly;BMS;Boehringer Ingelheim;MSD;Roche A Prat: Honoraria (institution), Speaker Bureau/Expert testimony: Roche;Honoraria (institution), Advisory/Consultancy, Speaker Bureau/Expert testimony: Pfizer;Novartis;Amgen;Speaker Bureau/Expert testimony: BMS;Honoraria (institution), Speaker Bureau/Expert testimony: Daiichi Sankyo;Nanostring technologies;Advisory/Consultancy: Puma;Oncolytics Biotech;MSD;Honoraria (institution), Advisory/Consultancy: Lilly;Honoraria (institution): Boehringer;Sysmex Europa GmbH;Medica Scientia inno Research;Celgene;Astellas Pharma;Officer/Board of Directors: Breast International Group;Solti's Foundation;Leadership role: Actitud Frente al Cancer Foundation L Mezquita: Speaker Bureau/Expert testimony, Research grant/Funding (self), Travel/Accommodation/Expenses: Bristol-Myers Squibb;Speaker Bureau/Expert testimony: Tecnofarma;Speaker Bureau/Expert testimony, Non-remunerated activity/ies: AstraZeneca;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Roche;Research grant/Funding (self): Boehringer Ingelheim All other authors have declared no conflicts of interest