A European Society for Medical Oncology (ESMO) interdisciplinary expert consensus paper on how to manage patients with cancer during the COVID-19 pandemic was published by Giuseppe Curigliano, MD, PhD, and colleagues in Annals of Oncology. The guidance encourages medical oncologists worldwide not to discontinue or delay any type of anticancer treatment that may potentially impact overall survival of patients. The experts also urge to not classify all patients with cancer as vulnerable to coronavirus infection, since this may lead to inappropriate care and potential negative outcomes.
Giuseppe Curigliano, MD, PhD
The COVID-19 pandemic is challenging oncology experts to continue delivering quality cancer care while protecting patients from the risk of being exposed to the virus. Earlier this year, ESMO developed adapted guidelines for prioritizing the various aspects of cancer care across different tumor types, with the aim of mitigating the negative effects of the pandemic on the management of patients.
Establishment of Consensus Statement
An international consortium was established by ESMO to discuss current clinical evidence from cohort studies and to provide expert advice on significant clinical questions, from diagnosis to surgery related to cancer management in the COVID-19 era. The interdisciplinary expert panel— consisting of 64 experts and 1 voting patient advocate—agreed on 28 statements.
“The general advice is that whenever an anticancer treatment can impact overall survival of the patient, it should not be discontinued or delayed,” explained Dr. Curigliano, of the European Institute of Oncology, Milan, Italy.
The recommendation relies on the lack of convincing evidence that using immune checkpoint inhibitors, noncytotoxic targeted therapies, and some types of adjuvant or neoadjuvant systemic therapies is detrimental or, in principle, associated to a higher risk of complications or mortality.
“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 [the ESMO adapted guidelines],” added Dr. Curigliano.
Additional Statements
In the consensus paper, the interdisciplinary expert panel also warns against labeling all patients with cancer as vulnerable to COVID-19 irrespective of age, sex, tumor type, and disease stage. In fact, despite the fact that earlier in the pandemic, patients with cancer were reported to be at increased risk of contracting coronavirus and experiencing more severe infection, more recent evidence suggests that many patients with solid tumors are not more vulnerable to severe COVID-19 outcomes than the general population.
“Although it was reasonable to adopt overprotective 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 patients [with cancer] are vulnerable to [infection with] COVID-19,” continued Dr. Curigliano. “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 … approach in the … future.”'
Responding to the critical question about which patients with cancer who really may be at high risk for COVID-19 infection and severe outcomes, Dr. Curigliano concluded, “Based on current evidence, only patients who are elderly, with multiple comorbidities, and receiving chemotherapy are vulnerable to the infection. In this population, before starting any treatment, we recommend [testing] patients for COVID-19 with a real-time reverse transcription polymerase chain reaction, the current gold standard for diagnosis, in order to exclude that the patient is infected [with] the coronavirus.”
The set of statements published in the ESMO’s flagship journal has been designed to serve as a dynamic knowledge repository that will be better informed by accumulating further data on the SARS CoV-2 biology, pandemic characteristics, risks associated with COVID-19 among patients with cancer, modulating factors, and optimal cancer care in the presence of the virus.
Disclosure: For full disclosures of the study authors, visit annalsofoncology.org.
