- Patients with lung cancer are more at risk of pulmonary complications from COVID-19 disease and the risk: benefit ratio of systemic anticancer treatment has to be considered.1,2
- Practical suggestions to treat patients are proposed (see table 1 below).2
- Regarding Potential Surgery:
- Stage IIIA should be considered urgent and surgery should be done within one month if indicated and resources available. Surgery may still be preferred over non-surgical management.1
- Regarding adjuvant and neoadjuvant treatments:
- The risk: benefit ratio may favors not giving adjuvant therapy when the survival benefit is modest, following careful discussion with patients in terms of absolute risks.2
- Neoadjuvant treatments may become an attractive option as it may delay the need for surgery.2
- Regarding Radiation Therapy (RT):
- Palliative RT outside the lung, favoring a single fraction or two (8-10, 17 Gy), may not be denied and treatment to the lung should be limited to cases with compression of airways or bleeding.1,2
- Brain imaging (MRI) for surveillance may be preferred to PCI (prophylactic cranial irradiation) for limited and extensive stage SCLC (small cell lung cancer).1,2
- Thoracic consolidation RT should be avoided for extensive SCLC.2
- For stage III NSCLC (non-small cell lung cancer), RT should be started on day 1 of chemotherapy to limit the number of cycles to two.1,2
- Regarding Systemic Treatment:
- Curative-intent systemic therapy should be considered and uninterrepted. Delaying treatment up to four months postoperatively may be considered if resources are limited or if it’s the patient preference. Durvalumab may be differed for up to 6 weeks after chemo-radiation. 1
- Regimens with longer interval, including ICI (immune checkpoint inhibitors), should be preferred (eg, nivolumab 480 mg q 4 weeks of pembrolizumab 400 mg q 6 weeks).2
- Oral chemotherapy (etoposide, topotecan, temozolomide) should be prioritized to IV.1
- Shorter duration of chemotherapy should be discussed with patients (eg, 4 cycles instead of 6).1,2
- Maintenance chemotherapy may be withheld.1,2
- The use of prophylactic granulocyte colony-stimulating factor (G-CSF)and home delivery of antibiotics could have its benefits.1,2
This Table was taken from https://esmoopen.bmj.com/content/5/2/e000765 and is published under an open access license.
These are suggestions made by a group of expert from Italy and Switzerland. Given the heterogeneity of several factors (extent of the epidemic, local healthcare structure capacity, risk of infection to the individual, status of cancer, patients comorbidities, age and treatment) the authors made general suggestions to be adapted by each individual center.
Source:
- NCCN.org. Short-Term Recommadations for Non-Small Cell Lung Cancer Management During the COVID-19 Pandemic. Consulted on April 13, 2020. https://www.nccn.org/covid-19/
- Banna G., Curioni-Fontecedro A., Friedlaender A., Addeo A. (April 03, 2020). How we treat patients with lung cancer during the SARS-CoV-2 pandemic: primum non nocere. ESMO open. DOI:10.1136/esmoopen-2020-000765 https://esmoopen.bmj.com/content/5/2/e000765