CTA: In a recent paper in The Oncologist,3 you and other coauthors wrote that the consent process surrounding the receipt of anticancer therapies during the COVID-19 pandemic could change. In what specific ways do you predict this process could change?
Dr Chua: There is a recent case series in 28 patients published by Zhang et al. in the Annals of Oncology showing that patients who received anticancer therapies within 14 days of being infected with SARS-CoV-2 harbored a higher risk of death.4 Likewise, we have another paper currently under review suggesting the same trend.
In this instance, this aggravated risk has to be explained to patients when consenting them for anticancer treatment; specifically, emphasizing the point that they may face a higher risk of death should they become infected during treatment — be it surgery, chemotherapy or radiotherapy.
However, patients should also be reassured that if their anticancer treatment cannot be postponed, eg, head and neck cancer patients where a delay in treatment can lead to poorer outcomes, we do have tight infection-control measures in place to prevent patient-to-patient and patient-to-[health care worker] transmission.
CTA: The COVID-19 pandemic has already affected the supply chain for some medical products (such as treatments approved for lupus and other chronic conditions). What other medical products commonly used in cancer could be the next shortage targets as a result of interest in its use for COVID-19? (ie, tocilizumab, which is typically used for cytokine storm following administration of chimeric antigen receptor T-cell [CAR-T] therapies). What drugs are you particularly worried about, if any?
Dr Chua: Nothing really comes to mind. I am aware of another trial using ibrutinib to treat COVID-19. However, all these are currently being investigated in clinical trials, which should be the case, given that anecdotal evidence on clinical efficacy is often biased by success stories — the failed examples never really make it to the journals (for obvious reasons).
CTA: An upcoming presentation at AACR 2020 will look at the use of anticancer medications during the COVID-19 pandemic. Although there are very few published studies on the risk of susceptibility to SARS-CoV-2 depending on anticancer therapies used, what do you suspect could be the therapies that put patients with cancer at a higher risk of COVID-19 infection?
Dr Chua: Cytotoxic chemotherapy would be the obvious one. Additionally, there are some queries among the oncology community if concurrent or recent administration of immune checkpoint blockade therapies could worsen the COVID-19 illness trajectory. Alluding to my earlier comment, we have a paper under review that will provide some insights on the interaction of anticancer treatment and outcomes from COVID-19.
- Hope MD, Raptis CA, Henry TS. Chest computed tomography for detection of coronavirus disease 2019 (COVID-19): Don’t rush the science [published April 8, 2020]. Ann Intern Med. doi: 10.7326/M20-1382
- Rubin GD, Ryerson CJ, Haramati LB, et al. The role of chest imaging in patient management during the COVID-19 pandemic: A multinational consensus statement from the Fleischner Society [published online April 7, 2020]. Chest. doi: 10.1016/j.chest.2020.04.003
- Al‐Shamsi HO, Alhazzani W, Alhuraiji A, et al. Practical approach to the management of cancer patients during the novel coronavirus disease 2019 (COVID‐19) pandemic: An international collaborative group [published online April 3, 2020]. Oncologist. doi: 10.1634/theoncologist.2020-0213
- Zhang L, Zhu F, Xie L, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China [published online March 26, 2020]. Ann Oncol. doi: 10.1016/j.annonc.2020.03.296