The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection.
Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic.
We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19.
For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both.
mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy.
ESMO open. 2020 Jul [Epub]
Stefanie Aeppli, Eric Innocents Eboulet, Tim Eisen, Bernard Escudier, Stefanie Fischer, James Larkin, Viktor Gruenwald, David McDermott, Jan Oldenburg, Aurelius Omlin, Camillo Porta, Brian Rini, Manuela Schmidinger, Cora Sternberg, Christian Rothermundt
Medical Oncology and Haematology, Kantonsspital St Gallen, Sankt Gallen, Switzerland., Coordinating Center, Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland., Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK., Department Medical Oncology, Gustave Roussy, Villejuif, Île-de-France, France., Medical Oncology, Royal Marsden Hospital NHS Trust, London, London, UK., Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, University Hospital Essen, Essen, Germany., Kidney Cancer Program, Dana-Farber/Harvard Cancer Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA., Division of Medicine an Laboratory Sciences, Akershus University Hospital, Lorenskog, Norway., Biomedical Sciences and Human Oncology, Università degli Studi di Bari Aldo Moro, Bari, Italy., Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Medicine I, Clinical Division of Oncology, Vienna, Austria., Medical Oncology, Weill Cornell Medicine, New York, New York, USA., Medical Oncology and Haematology, Kantonsspital St Gallen, Sankt Gallen, Switzerland .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/32669298