Locally Advanced NSCLC and COVID-19: Alternative Treatment Strategies
Posted: Wednesday, June 3, 2020
As the COVID-19 pandemic spreads globally and continues to stress medical resources, a study published in the Journal of Thoracic Oncology shows that mortality risk is increased for patients undergoing treatment for locally advanced non–small cell lung cancer (NSCLC). Drew Moghanaki, MD, MPH, of Emory University, Atlanta, and colleagues suggest that alternative treatment strategies should be employed through communication with the multidisciplinary cancer team.
“Patients with newly diagnosed locally advanced NSCLC are a vulnerable population during the COVID-19 global pandemic,” the authors commented. “Standard-of-care strategies can take a long time to deliver and expose patients to multiple visits to health-care facilities.”
To reduce the risk of exposure and lessen the immunocompromising effects of lung cancer therapies, the authors offered several alternatives for consideration. If surgical resources are scarce and perioperative care poses a risk at a facility, patients with resectable disease can undergo definitive nonoperative management. If patients have COVID-19, cancer treatment may be put on hold until they are no longer showing symptoms.
Briefly, the modifications to standard of care during this time proposed by the authors focus on the following topics: hilar and mediastinal staging, surgical management, chemoradiation, and radiation techniques. Specifically, staging of the mediastinum with 18F-FDG-PET-CT or contrast CT, rather than endobronchial ultrasound or mediastinoscopy, is recommended. Surgery should be avoided in patients testing positive for SARS-CoV-2, even if they are asymptomatic. As for chemoradiation, the authors suggest considering sequential therapy or induction systemic therapy. As for radiation techniques, use of intensity-modulated radiation therapy with a hypofractionated schedule is recommended. In addition, any deviation in the standard of care should be discussed with all members of a patient’s care team as well as a multidisciplinary tumor board.
Disclosure: The study authors’ disclosure information can be found at www.jto.org.