Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome-coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy

GOECP/SEOR clinical recommendations for lung cancer radiotherapy during the COVID-19 pandemic

“…Even the recommendations of the Memorial Sloan-Kettering Cancer Center, a well-known supporter of neoadjuvant chemotherapy in selected stage III patients, do not include this indication[ 50 ]. The Fox Chase Cancer Center guidelines comprehensively address the treatment of NSCLC during the COVID-19 pandemic stating “Patients with resectable disease can be treated with definitive non-operative management if surgical resources are limited or the risks of perioperative care are high...”[ 51 ]. Nevertheless, it is essential that the treatment approach be individualised within the parameters set by an interdisciplinary tumour board.…”

https://researchopenworld.com/management-of-cancer-patients-undergoing-radiation-therapy-during-the-novel-coronavirus-disease-2019-covid-19-pandemic-a-review-of-the-literature/#

“…Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic are provided in an ESTRO-ASTRO consensus statement by Guckenberger et al Singh et al and Dingemans et al also make recommendations on standardizing the care of lung cancer patients during COVID-19 while recommending that general standard principles of practice be followed [33][34][35]. Wu et al provide guidelines for thoracic radiation therapy specifically while Kumar et al discusses alternative management options [36,37].…”

Evaluation of non-small cell lung cancer treatment strategies in a region of China with low-risk for COVID-19

“…Many researchers have proposed guidelines to manage this vulnerable population. Kumar S et al [9] suggested that in the case of limited surgical resources or high risks associated with perioperative care, NSCLC patients who presented with advanced yet localized disease that was resectable could be treated with speci c, non-surgical management, including chemotherapy, chemoimmunotherapy, radiation therapy, and immunotherapy. A previous consensus statement suggested that during the COVID-19 pandemic, the annual screening exam and treatment of clinical stage I NSCLC should be delayed [10] .…”