Abstract 1777P
Background
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.
Methods
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).
Results
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 |
| Form | Form | |||||||||
| 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 |
| 2C | 2C | |||||||||
| 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 |
| 2A | 2B | |||||||||
| 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 |
| 2C | 2C |
Conclusions
Maintaining use of ESMO-MCBS during the COVID-19 pandemic is possible with some changes in use of healthcare resources.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.