De-escalating cancer treatments during COVID 19 pandemic: Is metronomic chemotherapy a reasonable option?

Fedele, Palma; Sanna, Valeria; Fancellu, Alessandro; Marino, Antonella; Calvani, Nicola; Cinieri, Saverio

doi:10.1016/j.critrevonc.2020.103148

Cited by 12 publications

(19 citation statements)

References 122 publications

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“…As stated by different position papers published during this period of pandemic, oral chemotherapy was recommended to limit the access of cancer patients to hospitals and to guarantee the continuation of treatment in some cases [ 131 ]. COVID-19 pandemic forced us to review our strategies, in order to maintain the clinical care, and the consent process [ 116 ].…”

Section: Metronomic Chemotherapy Public Health Emergencies and Equality In Treatment Access: The Lesson Of Covid-19 Pandemicmentioning

confidence: 99%

Metronomic Chemotherapy

Cazzaniga

Cordani

Capici³

et al. 2021

Cancers

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Metronomic chemotherapy treatment (mCHT) refers to the chronic administration of low doses chemotherapy that can sustain prolonged, and active plasma levels of drugs, producing favorable tolerability and it is a new promising therapeutic approach in solid and in hematologic tumors. mCHT has not only a direct effect on tumor cells, but also an action on cell microenvironment, by inhibiting tumor angiogenesis, or promoting immune response and for these reasons can be considered a multi-target therapy itself. Here we review the state of the art of mCHT use in some classical tumour types, such as breast and no small cell lung cancer (NSCLC), see what is new regarding most recent data in different cancer types, such as glioblastoma (GBL) and acute myeloid leukemia (AML), and new drugs with potential metronomic administration. Finally, a look at the strategic use of mCHT in the context of health emergencies, or in low –and middle-income countries (LMICs), where access to adequate healthcare is often not easy, is mandatory, as we always need to bear in in mind that equity in care must be a compulsory part of our medical work and research.

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Section: Metronomic Chemotherapy Public Health Emergencies and Equality In Treatment Access: The Lesson Of Covid-19 Pandemicmentioning

confidence: 99%

Metronomic Chemotherapy

Cazzaniga

Cordani

Capici³

et al. 2021

Cancers

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“…This intervention can hopefully control the tumors and has more favorable safety profiles. In addition to the approaches mentioned above, the continuation of cancer care during the pandemic would be enhanced if oral administration of the medication was possible 80 . Nevertheless, SARS‐CoV‐2 RT‐PCR testing should be carried out before initiating the treatment in all cases with an urgent need for chemotherapy.…”

Section: Challenges For Chemotherapy During the Pandemicmentioning

confidence: 99%

Challenges posed by COVID‐19 in cancer patients: A narrative review

et al. 2021

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A novel coronavirus, or severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), was identified as the causative agent of coronavirus disease 2019 (COVID‐19). In early 2020, the World Health Organization declared COVID‐19 the sixth public health emergency of international concern. The COVID‐19 pandemic has substantially affected many groups within the general population, but particularly those with extant clinical conditions, such as having or being treated for cancer. Cancer patients are at a higher risk of developing severe COVID‐19 since the malignancy and chemotherapy may negatively affect the immune system, and their immunocompromised condition also increases the risk of infection. Substantial international efforts are currently underway to develop specific methods for diagnosing and treating COVID‐19. However, cancer patients’ risk profiles, management, and outcomes are not well understood. Thus, the main objective of this review is to discuss the relevant evidence to understand the prognosis of COVID‐19 infections in cancer patients more clearly, as well as helping to improve the clinical management of these patients.

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“…The use of systemic therapy in patients with early HCC deserves some reflection. While neoadjuvant chemotherapy may represent an acceptable option for safely postponing surgical intervention in various cancers, it should be recognized that for patients with small HCC, there are no effective preoperative chemotherapy protocols[ 14 , 26 , 38 , 60 ]. This implies that a lack of a response to chemotherapy would inevitably cause disease progression and may result in non-resectability.…”

Section: Bridging Systemic Treatmentmentioning

confidence: 99%

Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations

Fancellu

Sanna

Scognamillo

et al. 2021

WJCC

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The new coronavirus disease 2019 (COVID-19) pandemic has resulted in a global health emergency that has also caused profound changes in the treatment of cancer. The management of hepatocellular carcinoma (HCC) across the world has been modified according to the scarcity of care resources that have been diverted mostly to face the surge of hospitalized COVID-19 patients. Oncological and hepatobiliary societies have drafted recommendations regarding the adaptation of guidelines for the management of HCC to the current healthcare situation. This review focuses on specific recommendations for the surgical treatment of HCC ( i.e. , hepatic resection and liver transplantation), which still represents the best chance of cure for patients with very early and early HCC. While surgery should be pursued for very selected patients in institutions where standards of care are maintained, alternative or bridging methods, mostly thermoablation and transarterial therapies, can be used until surgery can be performed. The prognosis of patients with HCC largely depends on both the characteristics of the tumour and the stage of underlying liver disease. Risk stratification plays a pivotal role in determining the most appropriate treatment for each case and needs to balance the chance of cure and the risk of COVID-19 infection during hospitalization. Current recommendations have been critically reviewed to provide a reference for best practices in the clinical setting, with adaptation based on pandemic trends and categorization according to COVID-19 prevalence.

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De-escalating cancer treatments during COVID 19 pandemic: Is metronomic chemotherapy a reasonable option?

Abstract: Graphical abstract

Cited by 12 publications

References 122 publications

Metronomic Chemotherapy

Metronomic Chemotherapy

Challenges posed by COVID‐19 in cancer patients: A narrative review

Surgical treatment of hepatocellular carcinoma in the era of COVID-19 pandemic: A comprehensive review of current recommendations

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