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COVID-19 Pandemic–Related Challenges in Lung Cancer Therapy

By: Celeste L. Dixon
Posted: Friday, May 22, 2020

The coronavirus 2019 (COVID-19) pandemic can “pose a major challenge” to clinicians in that COVID-19 symptoms can resemble those of both worsening disease and immune checkpoint inhibitor–induced pneumonitis, according to Luana Calabrò, MD, PhD, of the University Hospital of Siena, Italy, and colleagues in The Lancet Respiratory Medicine. Also, part of this “dismal scenario” is “the prioritization of health support towards patients with COVID-19…. Physicians are increasingly being forced to select which patients should receive anticancer therapy on the basis of who is most likely to have a positive outcome,” they claimed. However, the authors emphasized, “The clinical and biological aggressiveness of lung malignancies clearly does not allow for anticancer therapy to be withheld or postponed.”

As for the symptom challenge, Dr. Calabrò and her team described the early phase of COVID-19–induced pneumonia as including such findings as multifocal peripheral and basal ground-glass opacities, crazy paving patterns, and traction bronchiectasis, while more advanced cases, after “a progressive transition to consolidation, [include] pleural effusion, extensive small lung nodules, irregular interlobular or septal thickening, and adenopathies.” These symptoms can mirror findings in progressing lung cancer or in concomitant pneumonia due to overlapping opportunistic infections, they stated, but “these specific conditions require very different therapeutic approaches.”

The same is true of similar-appearing symptoms in pneumonitis induced by immune checkpoint inhibitor (ICI) therapy (more common in patients with lung cancer than in those with other malignancies); radiologic patterns of interstitial-like pneumonitis induced by tyrosine kinase inhibitors, particularly osimertinib; and COVID-19–induced pneumonia. What’s more, like those of COVID-19 infection, “the clinical symptoms of ICI-induced pneumonitis are often not specific, consisting mainly of cough (or its worsening), chest pain, dyspnea, and fever,” the team noted.

They added a simple closing reminder: All patients with lung cancer should undergo systematic testing for COVID-19 at the beginning of their treatment and again whenever deemed necessary by their physician.

Disclosure: The study authors’ disclosure information can be found at thelancet.com.



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