Expert Panel Updates Guidelines for Anti-Cancer Treatment Amid COVID-19

Despite the risk of being exposed to the novel coronavirus disease 2019 (COVID-19), a new paper urged global oncologists not to delay any type of anti-cancer treatment that may potentially impact overall survival.

The European Society for Medical Oncology (ESMO) interdisciplinary expert consensus paper on how to manage cancer patients during the COVID-19 pandemic also encouraged oncologists to stop labeling all patients with cancer as vulnerable to coronavirus infection, “since this may lead to inappropriate care and potential negative outcomes,” ESMO said in a news release.¹

ESMO’s paper was published July 31, 2020 in Annals of Oncology.²

ESMO noted that, in the early days of the pandemic, patients with cancer were reported to be at increased risk of contracting the coronavirus infection and developing more severe infections. Now, evidence suggests that many patients with solid tumors are not more vulnerable to COVID-19 severe outcomes than the general population.

"Although it was reasonable to adopt over-protective measures for our patients at the outbreak of a novel infective disease which was not previously observed in humans, we now need to step away from the assumption that all cancer patients are vulnerable to COVID-19,” said Giuseppe Curigliano, MD, PhD, first author of the consensus paper, head of the Division of Early Drug Development at European Institute of Oncology, and associate professor of medical oncology the University of Milano in Milan, Italy.

"The implications have been important because, for some patients, treatment was delayed or interrupted over the last few months, and I believe that we will see the impact of this over-precautionary approach in the next future,” Curigliano added.

Earlier this year, ESMO developed adapted guidelines³ for prioritizing the various aspects of cancer care across different tumor types, aiming to mitigate the negative effects of the pandemic on cancer care. 

Recommendations within the guidelines identified specific risk groups:

• Patients receiving chemotherapy, or who have received chemotherapy in the last 3 months
• Patients receiving extensive radiotherapy
• Individuals who have had bone marrow or stem transplants in the last 6 months, or who are still taking immunosuppressive drugs
• Individuals with some types of blood of lymphatic system cancer which damage the immune system even if they have not needed treatment (ie chronic leukaemia, lymphoma or myeloma)

ESMO also established an interdisciplinary expert panel to discuss current clinical evidence from cohort studies and to provide expert advice on significant clinical open questions — from diagnosis to surgery related to cancer management in the COVID-19 era. The panel agreed on 28 final statements.

“The general advice is that whenever an anti-cancer treatment can impact overall survival of the patient, it should not be discontinued or delayed," Curigliano said. "Of course, case-by-case discussions run by multidisciplinary teams remain pivotal to balance the risk of being infected against tumor control, as stated in our previous work," he continued.

Based on current evidence, patients who are older adults, have comorbidities including chronic respiratory, cardiovascular or chronic kidney disease and diabetes, or have been receiving chemotherapy are vulnerable to contracting COVID-19, Curigliano said. “In this population, before starting any treatment, we recommend to test patients for COVID-19 with a real-time RT-PCR (reverse transcription polymerase chain reaction), the current gold standard for diagnosis, in order to exclude that the patient is infected by the coronavirus.”

References:

1. ESMO experts: Do not discontinue or delay cancer treatment impacting on overall survival. European Society for Medical Oncology; July 31, 2020. Accessed August 4, 2020. https://www.eurekalert.org/pub_releases/2020-07/esfm-eed073020.php
2. Curgiliano, G. Managing Cancer Patients During the COVID-19 Pandemic: An ESMO Interdisciplinary Expert Consensus. Annals of Oncology. July 31, 2020. Accessed August 4, 2020. https://www.annalsofoncology.org/article/S0923-7534(20)39948-8/fulltext
3. Cancer Patient Management During the COIVD-19 Pandemic. European Society for Medical Oncology. Accessed August 4, 2020. https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic