Lung cancer

Changes in therapy for lung cancer patients may be needed due to COVID-19

The impact of COVID-19 on the management of patients with non-small cell lung cancer (NSCLC) will take some time to unfold in full but early evidence suggests the infection warrants a change in the duration and type of cancer treatment.

A Commentary article in Future Medicine by Australian authors said the pandemic poses significant challenges for the treatment of all cancer patients, but particularly for lung cancer patients where an increase in mortality has also been reported.

The authors referred to a Chinese study of 28 COVID-19-infected cancer patients from three hospitals in Wuhan.

The study, published in Annals of Oncology, found 25% of the patients had lung cancer and they typically exhibited a more rapid progression of COVID-19 disease than patients with other cancer types.

The case series had a high rate of serious events (56%) including admission to ICU, mechanical ventilation or death, compared to 4.7% in the general COVID-19 infected population.

In particular, patients who had received an anti-tumour treatment within 14 days of their COVID-19 diagnosis had a significantly increased risk of developing COVID-19 severe events (HR = 4.079, 95% CI 1.086–15.322, P = 0.037).

The Australian team, including Dr Steven Kao from the Chris O’Brien Lifehouse, said it was not clear whether the treatment modality mediated this risk.

“Although it is difficult to draw a conclusion from this series due to small numbers, it is reasonable to make the assumption that cytotoxic chemotherapy would be more immunosuppressive than immunotherapy, and hence more harmful in patients with COVID-19 coinfection.”

And clinicians might be more inclined to use single agent immunotherapy than combination chemoimmunotherapy.

They said the duration of treatment should also be considered when planning to reduce direct patient interactions with the healthcare system during a pandemic.

“With concerns about recent treatment for cancer increasing the risk of serious events with COVID-19, keeping the duration of treatment to an appropriate time would be important.”

“Therefore, it may be reasonable to discuss stopping treatments in patients who have achieved a complete response or prolonged response for more than 2 years during this COVID-19 pandemic,” they said.

“Telehealth will undoubtedly replace a large proportion of face-to-face consultation and treatment protocols involving less chair time will likely be preferentially used.”

Dr Kao and colleagues said the impact of COVID-19 on immune-related adverse events associated with immunotherapy in lung cancer patients will be an area of ongoing interest.

And there was some overlap between the radiological features seen in COVID-19 and irAEs such as pneumonitis.

“The differential diagnosis of PD-1-induced pneumonitis may complicate the management of patients receiving PD-1 therapy and suspected of being infected with COVID-19,” they said.

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