Amidst Covid-19, 13 specifications recommended by ESMO for Metastatic Breast Cancer

The constant news of the Covid-19 outbreak can be worrying. In March 2020, the World Health Organization declared the COVID- 19 a global pandemic. Most people infected with the COVID-19 virus experience mild to moderate respiratory illness, fever, dry throat, coughing. 

The pandemic created new difficulties for breast cancer specialists and breast cancer treatment of the patients. For the fast-evolving situation, pragmatic actions are required to deal with the challenges of patient treatment while ensuring their safety. In the wake of such extraordinary circumstances, ESMO (European Society for Medical Oncology) prioritized 13 specific ESMO recommendations for metastatic Breast cancer. Acknowledging the national legislation and guidance, some recommendations should be followed. So it is best to consult the Best Oncologist in Delhi NCR to gather a clear picture.

The 13 specific ESMO recommendations for Metastatic Breast Cancer are:

1. When chemotherapy is recommended, prefer oral treatments with the help of mobile devices to reduce access to the hospital.
2. Chemotherapy schedules may be changed to reduce clinical visits (for instance, using 3- weekly dosing instead of weekly dosing for selected agents when appropriate). Patients should receive G-CSF growth factor support to minimize Neutropenia (abnormally low white blood cells), while the use of Dexamethasone (medication) should be limited to reduce immunosuppression.
3. LHRH (Luteinizing Hormone-Releasing Hormone) are drugs that control testosterone levels. LHRH analog may be given for a longer effect, which is effective for three months to reduce patients’ visits to the hospital. Another option is a visiting nurse for LHRH analog administration at home.
4. Endocrine therapies: oral agents used widely in the adjuvant or metastatic setting (e.g., tamoxifen, aromatase inhibitors) should not affect immune function and can be safely continued. Fulvestrant should not affect the immune function but requires monthly I.M administration.
5. Implement telemedicine safety monitoring whenever possible.
6. All patients must be assured of the best home-based supportive care and symptom-control via telemedicine.
7. Bone agents are antiresorptive drugs that are used to increase bone strength. Bone agents should be delivered to bone metastasis patients with minimal hospital access.
8. The incorporation of CDK4/6 inhibitors (drugs) to endocrine treatments should align with ongoing recommendations, the local practice, and resource availability. The risk associated with Neutropenia has not been clearly defined and demands research implementation. Close monitoring for symptoms of infection is recommended, to promptly withdraw the treatment, and possibly refer to COVID – 19 diagnostic pathway.
9. The choice of postponing the incorporation of CDK4/6 (drugs) in the first line, for patients presenting with special patterns of disease (e.g., bone only, low burden, de novo metastatic disease) could be an option, especially in the elderly population.
10. The first-line treatment for patients with advanced-metastatic TNBC can be defined based on biomarkers, according to resource availability and local practice. For patients with PD-L1-positive TNBC, immunotherapy could be considered. The risk associated with immunotherapy in the onset and progression of COVID- 19 has not been clearly described and demands research and implementation. Close monitoring for pneumonitis, infection, or specific symptoms is recommended, to promptly withdraw the treatment and possibly refer to COVID-19 diagnostic pathway.
11. Oral chemotherapy agents should be prioritized, if possible, and should be prescribed for multiple courses and managed via telemedicine, for the common and manageable toxicities.
12. The addition of mTOR or PI3KCA inhibitors is not of immediate priority and can be avoided. The induced immune-suppression (Everolimus), risk of diabetes (alpelisib), the risk for pulmonary side effects demanding CT scan and other healthcare services overlapping with the COVID -19 algorithm could be a reason to postpone the incorporation of these agents in the later stages(e.g., in frailer patients with multiple COVID-19 risks – increasing comorbidities).
13. A team of breast cancer specialists who are involved at differing stages of a cancer patient’s management plan (known as multidisciplinary tumor board) came at a conclusion regarding patient preference.

They implied that a discussion regarding drug holidays, best supportive care, and delayed regiments or de-escalated maintenance regimens should be arranged whenever appropriate, to schedule the time table of treatment, and arrange less contact with the hospital.

These are tough times, and it is mandatory for mankind to stay together and help each other. If you are undergoing Breast Cancer Treatment in Noida, then you should take assistance from Dr. Manish Singhal. As the best Oncologist in Delhi NCR, Dr. Singhal provides technologically advanced breast cancer treatment with a holistic approach for the well-being of his cancer patients.

Also Read: Uncover the myths and realities of COVID-19 in lung cancer patients