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

Table 1 Retrospective reports about cancer patients with severe acute respiratory syndrome coronavirus 2 infection

Ref.	n1	Mean age	Outcomes	Results
Liang et al[74], 2020	18	63	Severe clinical events (ICU admission and mechanical ventilation or death)	Severe clinical events: 39% (7/18 patients) vs 8% (126/1572 patients without cancer) (P = 0.0003)
Zhang et al[72], 2020	28	65	Severe clinical events (ICU admission, life-threatening complications or death)	Severe clinical events: 53.6% (15/28 patients). Death rate: 28.6% (8/28 patients)
Dai et al[75], 2020	105	64	Death rate, ICU admission and severe or critical symptom	Death rate: 11.4% (OR 2.34, P = 0.03); ICU admission: 19.0% (OR 2.84, P < 0.01); Severe or critical symptom: 34.3% (OR 2.79, P < 0.01)
Barlesi et al[79], 20202	137	61	ICU admission or death	ICU admission: 11.0% (15/137 patients); Death rate: 14.6% (20/137patients)
Yang et al[76], 2020	205	63	ICU admission or death	ICU admission: 15.0% (30/205 patients); Death rate: 20.0% (40/205 patients)
Kuderer et al[77], 2020	928	66	ICU admission, mechanical ventilation or death	ICU admission: 14.2% (132/928 patients); Mechanical ventilation: 12.5% (116/928 patients); Death rate: 13.0% (121/928patients)
Garassino et al[78], 20203	200	68	ICU admission, mechanical ventilation in hospitalised patient and death in all patients	ICU admission: 8.8% (13/147 patients); Mechanical ventilation: 6.1% (9/147 patients); Death rate: 33.0% (66/200 patients)

¹Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed and cancer.

²Results reported at congress, some patient are not discharged at the time of calculate finals outcomes.

³Results from a cohort with thoracic malignancies and SARS-CoV-2 confirmed infection. ICU: Intensive care unit.

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.