Management of cancer patients during COVID-19 pandemic at developing countries

Table 2 Proposal for an approach to cancer therapies that should be prioritized in the event of a pandemic

Priority	Clinical scenario	Examples
High	Tumors with high early mortality associated and high response rate to treatment	Advanced germ cell tumors, lymphomas or acute leukemias
	Definitive curative cancer treatments	CRT for head and neck, cervical or anal cancers
Intermediate	Neoadjuvant or adjuvant therapies with high survival benefit	Perioperative ChT for gastric cancer and neoadjuvant CRT for localized rectal cancer. Adjuvant ChT for stage III or high risk stage II colorectal cancer, or stage III melanoma. ChT and RT for high risk breast cancer
	Neoadjuvant or adjuvant indications with modest survival benefit	Neoadjuvant ChT for muscle invasive bladder cancer. Adjuvant ChT for NSCLC, gallbladder and pancreatic cancer or gynecologic malignancies
	Palliative indications with high survival benefit	Immunotherapy for melanoma, NSCLC (with PDL1 > 50%) or high risk kidney cancer. Systemic ChT for metastatic breast or colorectal cancer. Molecular targeted therapy for NSCLC with driver mutation. TKI for GIST or low risk kidney cancer, and ADT and abiraterone or docetaxel for castrate-sensitive prostate cancer
Low	Palliative indications with modest survival benefit	Palliative chemotherapy for upper gastrointestinal cancers. Chemotherapy for gallbladder or pancreatic cancer, SCLC or bladder cancer
	Palliative indications without benefits in terms of overall survival	Second and third line palliative ChT for many solid tumors, as regorafenib for colorectal cancer or ramucirumab and placlitaxel for gastric cancer

CRT: Chemoradiotherapy; ChT: Chemotherapy; NSCLC: Non small cell lung cancer; RT: Radiotherapy; SCLC: Small cell lung cancer; TKI: Tyrosin kinase inhibitors; ADT: Androgen deprivation therapy; PDL1: Programmed death-ligand 1; GIST: Gastrointestinal stromal tumors.