Individuals whose adjuvant chemotherapy was intentionally postponed this spring may face the same prospects if a second wave of COVID-19 hits in the fall. Some experts recommend switching such patients to precision medicine-targeted treatment
As the coronavirus pandemic unfolded, adjuvant chemotherapy was intentionally postponed in certain patients with stable cancer. This presented a challenge for health system leaders and providers, who are now bracing for the potential consequences of delaying care. Facing the prospect of a second wave of COVID-19 in the fall, some hospital executives and clinicians see an opportunity to do things differently.
That's why the headline for an item posted in Targeted Oncology caught our attention. "COVID-19 Presents an Opportunity for Precision Medicine to Play Expanded Role in Care." Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, wrote, "Providers caring for cancer patients undergoing cytotoxic chemotherapy need to consider changing their treatment when feasible to reduce the risk of life-threatening complications as well as reducing the frequency of their visits to clinics. … Precision medicine-guided targeted therapies as well as immunotherapy may have a special role in identifying appropriate patients who may be in need for cancer treatment."
For Targeted Oncology, Kashyap Patel, MD, CEO of Carolina Blood and Cancer Care, detailed a new precision medicine
treatment approach for cancer patients undergoing cytotoxic chemotherapy during the COVID-19 pandemic. (Photo source: LinkedIn.)
Patel proposed a triage approach of sorts, identifying patients who should be given top, intermediate, and low priority with precision medicine-guided targeted agents.
- Top priority: Patients with newly-diagnosed aggressive tumors. Consider immunotherapy, targeted agents, and oral medications, including Bruton's tyrosine kinase (BTK) inhibitors, venetoclax, anti-epidermal growth factor receptors (EGFRs), tyrosine kinase inhibitors (TKIs), poly ADP-ribose polymerase (PARP) inhibitors, FMS-like tyrosine kinase 3 (FLT3) inhibitors, and BRAF inhibitors.
- Intermediate priority: Patients who require ongoing outpatient chemotherapy. For those able to be switched to oral agents, consider those with reduced immunosuppression, as follows:
- Lymphoma: convert to BTKs, targeted therapies, or TKIs
- Ovarian cancer: PARP inhibitors
- Breast cancer: cyclin-dependent kinase (CDK) 4/6 inhibitors
- Prostate cancer, multiple myeloma, high-grade myelodysplastic syndrome (MDS), chronic lymphocytic leukemia (CLL), and mantle cell lymphoma (MCL): when feasible, convert to an all-oral regimen
- Low priority: Patients receiving maintenance regimens who are in deep remission. Manage via telehealth; reschedule for less frequent follow-up. These patients include those with:
- Low-grade MDS
- Low-grade lymphoma
- Smoldering multiple myeloma
- Stage B colon cancer
- Early-stage breast cancer
- Monoclonal gammopathy of undetermined significance (MGUS)
Stratifying Prostate Cancer Risk
Meanwhile, according to a report in Urology Times, precision medicine tools, including prostate cancer biomarker tests, are playing an increased role in stratifying high- to low-risk individuals with prostate cancer.
"While most of us are familiar with the use of biomarkers, the COVID-19 pandemic amplifies the potential value they bring to help identify which patients' follow-up appointments might be postponed and which patients benefit from more immediate care," wrote Neal D. Shore, MD, FACS, Medical Director for the Carolina Urologic Research Center in Myrtle Beach, South Carolina.
Shore published a chart with his article covering which biomarker tests to use by cancer stage, which he hopes can "help inform and accelerate the prostate diagnosis and management decision-making process-a benefit that we can offer during this health care crisis." He added that the tools listed in the chart do not place burden on large national laboratories that are inundated by COVID-19, since they are processed by independent labs.