Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic

• Authors: Sameera Kumar, Fox Chase Cancer Center; Steven Chmura, University of Chicago; Clifford Robinson, Washington University; Steven H. Lin, University of Texas MD Anderson Cancer Center; Shirish M. Gadgeel, University of Michigan; Jessica Donington, University of Chicago; Josephine Feliciano, Johns Hopkins University; Thomas E. Stinchcombe, Duke University; Maria Werner-Wasik, Thomas Jefferson University; Martin J. Edelman, Fox Chase Cancer Center; Drew Moghanaki, Emory University
• Journal Title: Journal of Thoracic Oncology
• Volume: Volume 15, Number 7
• Publisher: Elsevier Science Inc. | 2020-07-01, Pages 1137-1146
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jtho.2020.04.016
• Subjects: Health Sciences, Oncology; Health Sciences, Radiology; Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Respiratory System; Non-small cell lung cancer; Locally advanced; COVID; SARS-CoV-2; Cell lung-cancer; Positron emission tomography; Phase II trial; Radiation therapy; Hypofractionated radiotherapy; Concurrent chemotherapy; COVID-19; Chemoradiotherapy; Chemoradiation

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (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 of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an 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 the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome–coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of 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. The risk of severe treatment-related morbidity and mortality is increased 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.