Alternative Multidisciplinary Management Options for Locally Advanced Non-Small Cell Lung Cancer During the COVID-19 Global Pandemic

Kumar, Sameera; Chmura, Steven; Robinson, Clifford; Lin, Steven H.; Gadgeel, Shirish M.; Donington, Jessica; Feliciano, Josephine; Stinchcombe, Thomas E.; Werner-Wasik, Maria; Edelman, Martin J.; Moghanaki, Drew

Abstract: Importance The COVID-19 pandemic is currently accelerating. Patients with locally advanced non-small cell lung cancer (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 for severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Observation We present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus opinion of alternative strategies for the treatment of LA-NSCLC during a pandemic, though guiding data is scarce. The overarching goals of these approaches are to reduce the number of visits to a healthcare facility, reduce the risk of SARS-CoV-2 exposure, attenuate the immunocompromising effects of lung cancer therapies, and provide effective oncologic therapy. Patients with resectable disease can be treated with definitive non-operative management if surgical resources are limited or the risks of perioperative care are high. Non-operative 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 based on 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. Conclusions and Relevance The risk of severe treatment-related morbidity and mortality is significantly elevated 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.