Treatment of stage IV cancer during COVID19 pandemic is a challenge, and we need to maintain survival benefit, patient safety, and health care resources at the same time.
We used the ESMO-MCBS (Forms version 1.1 and cards) and ESMO recommendations for COVID-19 pandemic to launch local guidelines for first-line therapy for ABC, NSCLC and mCRC comparing ESMO-MCBS for the standard therapy (ST) and COVID-19 pandemic therapy (COT). We then compared prices (EGP) and price changes (PC).
General rules: For PS≥3 patients, chemotherapy was postponed. We applied COVID-19 precautions to all patients. Oral chemotherapy was the preferred option: Every three weeks regimens were preferred over weekly regimens. ABC: Anti CDK4/6 are still the best option for patients with HR+ HER2- in non-visceral crisis, with MCBS 3 or 4. TNBC: carboplatin-containing therapy is still the best option. HER2+3 Addition of carboplatin to combination of trastuzumab and paclitaxel every three weeks was confirmed to increase treatment benefit, PFS of 13.8 v 7.6 months (P=.005) (HR, 0.55; 95% CI, 0.46 to 0.64), RR (42% v 29%) MCBS for carboplatin=3, which is the COT (JCO 2006, 24:2786). Weekly trastuzumab + paclitaxel + carboplatin confirmed improvement in RR compared with every 3 weeks (42% versus 29%) l with an unadjusted odds ratio of 1.75 (P.0004). With limited survival benefit, and toxicity profile (JCO 2008:26:1642) MCBS for weekly regimen=1 using form 2C which is the current ST. mCRC all RAS wild type No change for the use of FOLFRI + cetuximab: MCBS=4 using an infusion pump for 5FU with certain precautions. NSCLC: No change as regard to recommendation for targeted therapy whenever there were indications for a patient with gene mutation: MCBS=4. Immunotherapy for patients with PDL1≥50%, only MCBS=5. Pemetrexed with cisplatin is the recommended option for a patient with PS ≥1 and PDL1<50 with MCBS=4. RTH: Palliative quick course RTH Table: 1777P
ESMO-MCBS and price changes for ABC, NSCLC and mCRC before and after COVID-19 pandemic in selected protocols.
|Scenario||ST||ST MCBS||ST price||ST MCBS reference||COT||COT price||COT MSBS||COT MCBS reference||change of MCBS||change of price|
|ABC with HER2- HR+ visceral crisis||docetaxel every three weeks||4||3000||Cancer 2008; 112:1455||oral vinorelbine||12000||3||Breast:2019 Jun; 45:7-14||-1||+3|
|mCRC RAS gene mutation||IFL/ bevacizumab||3||15000||N Engl J Med 2004; 350:2335||capecitabine/bevacizumab||15000||3||Lancet Oncol. 2013; 14:1077–85.||0||0|
|NSCLC PS=2||single agent paclitaxel or gemcitabine or vinorelbine||3||5000||J Thorac Oncol. 2008; 3: 728||oral vinorelbine||10000||3||ANTICANCER RESEARCH 32: 175-182 (2012)||0||+1|
Maintaining use of ESMO-MCBS during the COVID-19 pandemic is possible with some changes in use of healthcare resources.
Clinical trial identification
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Has not received any funding.
All authors have declared no conflicts of interest.