- Benefit of additional palliative chemotherapy for BC (breast cancer) may be small, therefore the risk: benefit ratio must be carefully discussed, keeping in mind the risk of exposition and the risk of immunosuppression.1
- Oral treatments or home administration may be preferred to reduce the risk of exposure.1,2,3
- Patients without symptoms of tumor progression may defer routine restaging scans.1,3
- Regarding RT (radiation therapy):
- Short palliative RT (radiation treatment) regimen should be offered if needed.2,3
- Regarding endocrine therapies:
- Endocrine treatments (eg, tamoxifen, aromatase inhibitors, LNRH agonist) are safe and can be continued during this pandemic.1,2
- Bone modifying treatment (denosumab, bisphosphonates) may be deferred in the absence of hypercalcemia in patients.1
- Regarding HER2+ targeted and related therapies:
- Trastuzumab, pertuzumab and related antibodies for HER2+ may be given at less frequent dosing intervals. Interrupting maintenance therapy may be considered if treatment induced >2 years of duration of tumor control and minimal disease burden.1 T-DM1 should be used carefully as it possess a risk of interstitial pneumopathy.2
- Oral target agents (CDK4/6, mTOR, PIK3CA inhibitors) continuation should be discussed with patients weighing the risk of adverse events.1
- Everolimus should be used with caution as it possesses a risk of interstitial pneumopathy and immunosuppression.2
- Regarding chemotherapy:
- If chemotherapy is administered, G-CSF (granulocyte colony-stimulating factor) should be considered1,2,3 even with regimen that have a risk of neutropenia <20%.1
These recommendations are not formal rules, as limited data is available. Its goal is to provide a framework of thinking.
Sources:
- NCCN.org. The COVID-19 Pandemic Breast Cancer Consortium : Dietz J.R., Moran M.S., Isakoff S.J., Kurtzman S.H., Willey S.C, Burstein H.J., Bleicher R.J., Lyons J.A., Sarantou T., Baron P.L., Steven R.E., Boolbol S.K., Anderson B.O., Shulman L.N., Gradishar W.J., Monticciolo D.L., Plecha D.M., Nelson H., Yao K.A. Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19. https://www.nccn.org/covid-19/
- Gligorov J., Bachelot T., Pierga J.Y., Antoine E.C., Balleyguier C., Barranger E., Belkacemi Y., Bonnefoi H., Bidard F-C., Ceugnart L., Classe J.M., Cottu P., Coutant C., Cutuli B., Dalenc F., Darai E., Dieras V., Dohollou N., Delaloge S. (April 1, 2020). COVID-19 and people followed for breast cancer: French guidelines for clinical practice of Nice-St Paul de Vence, in collaboration with Collège Nationale des Gynécologues et Obstétriciens Français (CNGOF), the Société d’Imagerie de la FEMme (SIFEM), the Société Française de Chirurgie Oncologique (SFCO), The Société Française de Sénologie et Pathologie Mammaire (SFSPM) and the French Breast Cancer Intergroup-UNICANCER (UCBG). https://doi.org/10.1016/j.bulcan.2020.03.008
- ESMO.org. ESMO management and treatment adapted recommandations in the COVID-19 era: breast cancer. https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic/breast-cancer-in-the-covid-19-era