Advertisement

The Management of Patients With Lung Cancer During the Outbreak of Coronavirus Disease 2019

  • Wen Ouyang
    Affiliations
    Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China
    Search for articles by this author
  • Jing Hu
    Affiliations
    Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China
    Search for articles by this author
  • Hongyan Zhang
    Affiliations
    Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China
    Search for articles by this author
  • Conghua Xie
    Correspondence
    Address for correspondence: Conghua Xie, MD, Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, Hubei 430071, People’s Republic of China.
    Affiliations
    Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China
    Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan University, Wuhan, People’s Republic of China
    Hubei Clinical Cancer Study Center, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China
    Search for articles by this author
Open ArchivePublished:May 23, 2020DOI:https://doi.org/10.1016/j.jtho.2020.05.003
      To the Editor:
      We thank Russano et al.
      • Russano M.
      • Citarella F.
      • Vincenzi B.
      • Tonini G.
      • Santini D.
      Coronavirus disease 2019 or lung cancer: what should we treat?.
      for their thoughtful comments on our report. To date, accumulating evidence suggests that patients with cancer are at higher risks of severe acute respiratory syndrome coronavirus 2 infections and more likely to have higher mortality than the general population.
      • Liang W.
      • Guan W.
      • Chen R.
      • et al.
      Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.
      ,
      • Yu J.
      • Ouyang W.
      • Chua M.L.K.
      • Xie C.
      SARS-CoV-2 transmission in cancer patients of a tertiary hospital in Wuhan [e-pub ahead of print]. JAMA Oncol.
      Lung cancer is one of the most common malignancies worldwide, the clinical manifestations and signs of which overlap with novel coronavirus disease 2019 (COVID-19). Therefore, the management of patients with lung cancer during the COVID-19 outbreak is raising concerns. We previously reported a case of a patient with EGFR T790M mutant lung cancer who continued osimertinib therapy despite the development of COVID-19,
      • Zhang H.
      • Huang Y.
      • Xie C.
      Treatment and outcome of a patient with lung cancer infected with severe acute respiratory syndrome coronavirus-2.
      indicating the feasibility and safety of maintaining targeted treatment in patients with good condition. Russano et al.
      • Russano M.
      • Citarella F.
      • Vincenzi B.
      • Tonini G.
      • Santini D.
      Coronavirus disease 2019 or lung cancer: what should we treat?.
      pointed out that patients harboring driver mutations just represent a minority of cases. Nevertheless, in contrast to the white population, patients with driver mutations account for approximately 50% to 60% of the east Asian population with nonsquamous NSCLC.
      • Meng H.
      • Guo X.
      • Sun D.
      • et al.
      Genomic profiling of driver gene mutations in Chinese patients with non-small cell lung cancer.
      In addition, some noncytotoxic drugs, such as antiangiogenesis agents, are also indicated for wild-type lung cancer. Therefore, our experience still benefits a considerable number of patients with lung cancer during the COVID-19 outbreak.
      Admittedly, we are facing complicated scenarios in clinical practice as stated by Russano et al.
      • Russano M.
      • Citarella F.
      • Vincenzi B.
      • Tonini G.
      • Santini D.
      Coronavirus disease 2019 or lung cancer: what should we treat?.
      Potential interactions between coronavirus and anticancer therapies may exist. Chemotherapy and radiotherapy are immunosuppressive and favor infectious complications, and immunotherapy might lead to immune-related events, the mechanisms of which overlap with lung injury in COVID-19. Therefore, it is reasonable to temporarily interrupt the abovementioned treatments pending recovery from COVID-19. On the basis of our single-institute data,
      • Yu J.
      • Ouyang W.
      • Chua M.L.K.
      • Xie C.
      SARS-CoV-2 transmission in cancer patients of a tertiary hospital in Wuhan [e-pub ahead of print]. JAMA Oncol.
      six patients with lung cancer without EGFR mutations were interrupted in anticancer treatment pending recovery from COVID-19. As of February 23, 2020, two had died from COVID-19. The other four discharged patients did not report cancer-related symptoms. The median hospitalization duration of the six patients with lung cancer for COVID-19 was 13 days, which indicated that the interruption of anticancer treatment was short.
      In addition, owing to concerns about potential severe acute respiratory syndrome coronavirus 2 infection, patients with cancer were suggested to reduce hospital visits during the epidemic episodes. The delay or interruption of anticancer treatment in patients without COVID-19 was controversial. We further investigated the impact based on our single-institute data.
      • Yu J.
      • Ouyang W.
      • Chua M.L.K.
      • Xie C.
      SARS-CoV-2 transmission in cancer patients of a tertiary hospital in Wuhan [e-pub ahead of print]. JAMA Oncol.
      Of the 288 hospitalized patients with lung cancer, 276 patients without COVID-19 have ongoing anticancer treatment. A total of 197 patients experienced treatment interruption, in which 50 might develop progression (Table 1). Compared with the patients continuing targeted therapy, a considerable proportion of cases were suspected to have progression owing to the delay of radiotherapy (10.7%) or periodic chemotherapy and immunotherapy (26.0%). Therefore, we suggested that life-saving chemotherapy and radiotherapy with curative intent should be reserved and prioritized under strict quarantine measures.
      Table 1Outcomes of Patients With Lung Cancer Without SARS-CoV-2 Infection Treated at the Zhongnan Hospital of Wuhan University
      RT n = 28, n (%)CT and Immunotherapy n = 206, n (%)TKI n = 42, n (%)Total n = 276, n (%)
      Treatment on schedule014 (6.8)42 (100.0)56 (20.3)
      Switching from intravenous CT to an oral therapy023 (11.2)023 (8.3)
      Treatment interruption28 (100.0)169 (82.0)0197 (71.4)
      Reports of suspicious symptoms associated with progression3/28 (10.7)44/169 (26.0)NA50/197 (25.4)
      CT, chemotherapy; NA, not applicable; RT, radiotherapy; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TKI, tyrosine kinase inhibitor.
      Collectively, there is no easy, universal solution to oncologic care during this outbreak. Clinicians can make decisions on the basis of several variables, including the extent of the epidemic, capacity of local health care institutions, stage of cancer, intent of the treatment, and patients’ comorbidities and age. In these trying times, it is important to weigh comprehensively and individually these variables rather than to rely on a routine.

      References

        • Russano M.
        • Citarella F.
        • Vincenzi B.
        • Tonini G.
        • Santini D.
        Coronavirus disease 2019 or lung cancer: what should we treat?.
        J Thorac Oncol. 2020; 15: e105
        • Liang W.
        • Guan W.
        • Chen R.
        • et al.
        Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.
        Lancet Oncol. 2020; 21: 335-337
        • Yu J.
        • Ouyang W.
        • Chua M.L.K.
        • Xie C.
        SARS-CoV-2 transmission in cancer patients of a tertiary hospital in Wuhan [e-pub ahead of print]. JAMA Oncol.
        (accessed April 25, 2020)
        • Zhang H.
        • Huang Y.
        • Xie C.
        Treatment and outcome of a patient with lung cancer infected with severe acute respiratory syndrome coronavirus-2.
        J Thorac Oncol. 2020; 15: e63-e64
        • Meng H.
        • Guo X.
        • Sun D.
        • et al.
        Genomic profiling of driver gene mutations in Chinese patients with non-small cell lung cancer.
        Front Genet. 2019; 10: 1008

      Linked Article

      • Coronavirus Disease 2019 or Lung Cancer: What Should We Treat?
        Journal of Thoracic OncologyVol. 15Issue 7
        • Preview
          Management of patients with lung cancer in the era of coronavirus disease 2019 (COVID-19) has become a global concern. We read with great interest the article written by Zhang et al.,1 who first reported the treatment and outcome of a patient with lung cancer infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A 57-year-old Chinese man affected by advanced lung adenocarcinoma harboring EGFR L858R mutation continued targeted therapy with osimertinib despite development of COVID-19 pneumonia.
        • Full-Text
        • PDF
        Open Archive