“COVID-friendly” Cancer Treatments – What Will Be the Lasting Impact of Interim Access?

General

• Prophylactic daily granulocyte-colony stimulating factor (G-CSF) or a biosimilar PEGylated G-CSF to prevent neutropenic fever and reduce admissions (for example, for patients on chemotherapy regimens with a greater than 10% risk of neutropenic fever)

Acute myeloid leukemia (AML)

• Venetoclax with either low-dose cytarabine or azacitidine instead of standard induction chemotherapy for newly diagnosed acute myeloid leukemia

Bladder cancer

• Use atezolizumab as first-line immunotherapy instead of chemotherapy

Breast cancer

• Consider reducing the duration of adjuvant trastuzumab monotherapy from 12 months to 6 months
• Consider giving pertuzumab plus trastuzumab for neo-adjuvant therapy, adjuvant therapy, locally recurrent or metastatic disease without chemotherapy
• Switch to oral capecitabine from intravenous taxanes with anti-HER2 therapies
• Substitute albumin-bound paclitaxel (Abraxane) for paclitaxel or docetaxel t

Colorectal cancer

• Give intermittent treatment with chemotherapy regimens that contain cetuximab or panitumumab
• Give nivolumab as immunotherapy instead of chemotherapy

Endometrial cancer

• Give nivolumab instead of chemotherapy for microsatellite instability-high tumors

Gestational or placental site trophoblastic tumor

• Use pembrolizumab first-line or subsequent line instead of combination chemotherapy

Lung cancer (non-small cell)

• Stop maintenance pemetrexed in combination with pembrolizumab
• Give pembrolizumab as a single agent as a first-line treatment for squamous or nonsquamous non-small cell lung cancer and a PDL-1 score of less than 50%
• Allow durvalumab to be given 4-weekly in patients eligible for durvalumab following treatment with chemotherapy

Lymphoma (Hodgkin)

• Give brentuximab earlier in treatment pathway to replace salvage chemotherapy
• Give nivolumab earlier in treatment pathway – after brentuximab to replace salvage chemotherapy

Lymphoma (Non-Hodgkin)

• Consider suspending rituximab maintenance to avoid patients attending hospital
• Consider suspending obinutuzumab maintenance to avoid patients attending hospital
• Switch intravenous rituximab to subcutaneous rituximab in follicular lymphoma patients receiving rituximab with lenalidomide
• Give oral ibrutinib (with or without rituximab) first-line instead of intravenous chemotherapy

Mesothelioma

• Give nivolumab monotherapy instead of second-line chemotherapy

Myeloma

• Give oral pomalidomide with dexamethasone as second- or third-line therapy instead of intravenous treatments
• Give first-line lenalidomide and dexamethasone for transplant eligible myeloma patients in preference to regimens that need more hospital attendances
• Give lenalidomide as second-line treatment in patients with multiple myeloma
• Give second-line ixazomib with lenalidomide and dexamethasone for patients who are neither refractory to previous proteasome inhibitor-based treatment nor to lenalidomide-based treatment

Neuroendocrine tumors

• Give oral temozolomide and capecitabine instead of intravenous streptozocin and 5- fluorouracil t

Prostate cancer

• Give enzalutamide with androgen deprivation therapy for patients with newly diagnosed metastatic disease instead of docetaxel
• For patients who are intolerant to enzalutamide, give the option of switching treatment to abiraterone

Renal cell cancer

• Use nivolumab instead of chemotherapy for microsatellite instability-high tumors

Upper gastrointestinal cancers

• Use nivolumab instead of chemotherapy for microsatellite instability-high tumors