Alternative Multidisciplinary Management Options for Locally Advanced Non-Small Cell Lung Cancer During the COVID-19 Global Pandemic

Abstract

Importance: The COVID-19 pandemic is currently accelerating. Patients with locally advanced non-small cell lung cancer (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 for severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Observation: We present 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 to reduce the number of visits to a healthcare facility, reduce the risk of SARS-CoV-2 exposure, and attenuate the immunocompromising effects of lung cancer therapies. 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. Non-operative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules. The order of treatments may be based on patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypofractionated schedules are appropriate. For patients who are confirmed to have COVID-19, usually cancer therapies may be withheld until symptoms have resolved with negative viral test results. Conclusions and Relevance: The risk of severe treatment-related morbidity and mortality is significantly elevated for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment strategies as quickly as possible may save lives and should be implemented through communication with the multidisciplinary cancer team.

Recommendations for detection, prioritization, and treatment of thoracic oncology patients during the COVID‐19 pandemic: the THOCOoP cooperative group

“…Although hypofractioning is gaining acceptance, high technology is necessary in order to implement this modality. The dose should be 50−60 Gy in 25-30 fractions (Guckenberger et al, 2020;Kumar et al, 2020).…”

Lung Cancer and COVID-19: Therapeutic Implications

“…To further complicate the diagnosis, these alterations might not be present in early COVID-19 patients and they might be present in lung cancer patients due to the tumor or to the treatment that they are receiving [35]. Indeed, the radiological features associated to SARS-CoV-2 infection are similar to toxicities caused by immunotherapy treatments in lung cancer patients, increasing the struggle of COVID-19 diagnosis in these patients [36].…”

Challenges in Management of Patients With Lung Cancer in Times of COVID-19: An Imaging Perspective

“…There are few publications that address the clinical management of patients with LC in the current SARS-CoV-2 pandemic. 2 , 3 , 4 , 5 The clinical and radiologic manifestations of COVID-19 can mimic pulmonary toxicity or progression of tumor disease in patients with LC. 6 Some extrapulmonary complications of SARS-CoV-2 pneumonia may also simulate progression of cancer disease.…”