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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 334

Authors' reply to D'Souza et al.


Department of Medical Oncology, Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

Date of Submission10-May-2020
Date of Decision11-May-2020
Date of Acceptance11-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Ajay Gogia
Department of Medical Oncology, Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_189_20

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How to cite this article:
Chellapuram SK, Gogia A. Authors' reply to D'Souza et al. Cancer Res Stat Treat 2020;3:334

How to cite this URL:
Chellapuram SK, Gogia A. Authors' reply to D'Souza et al. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 9];3:334. Available from: http://www.crstonline.com/text.asp?2020/3/2/334/287235



The landscape of the coronavirus disease 2019 (COVID-19) pandemic is rapidly changing, and the recommendations given come with a rider of being dynamic and lacking the support of randomized controlled clinical trial data.[1] The recommendations also depend on the local pandemic status. It is, therefore, important that the final decision be individualized on a case-to-case basis.

We agree with the correspondents, D'Souza et al.,[2] that in case of low-risk, early-stage, node-negative, hormone receptor-positive breast cancers, four cycles of docetaxel plus cyclophosphamide is a reasonable option, and that targeted anti-HER2 therapy, including trastuzumab/pertuzumab/ado-trastuzumab emtansine may be given, as was done before the COVID-19 pandemic.[3] The role of home infusion chemotherapy, as suggested by D'Souza et al., might be logistically difficult in the Indian scenario, except in the case of very few fully motivated patients. There is a possibility that home infusions, if not given properly, may result in extravasation injuries and catheter-based infections. Injectable bisphosphonates can be delayed or substituted by denosumab or oral bisphosphonates.

The pathophysiology of COVID-19 is not yet clearly understood. The role of cytokine storm in causing end-organ damage is emerging. There is a concern that immunomodulatory drugs, such as the immunotherapeutic agents, may aggravate COVID-19.[4] In one of the largest available retrospective series of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection among patients with cancer, there was an increased mortality observed in patients who received immunotherapy.[5] In this analysis of 105 patients with cancer infected with SARS-CoV-2, six patients had previously received immunotherapy in the past 2 weeks. Two of these six patients (33.33%) died, and four (66.67%) developed critical symptoms. There is a recent case report of a patient who received immunotherapy for advanced lung cancer, in whom a subsequent infection with SARS-CoV-2 led to a stormy course of disease and death.[6],[7] In addition, differentiating non-infectious pneumonitis from infectious pneumonia is difficult. Based on these reports, we do not recommend giving immunotherapy and stress on the fact that the decision be based on individual doctor–patient interactions. Lastly, we agree with D'Souza et al.[2] that with time, we will be better equipped with more robust data in guiding our patients rationally.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Noronha V, Behel V. Catch-22: COVID versus cancer. Cancer Res Stat Treat 2020;3 Suppl S1:1-2.  Back to cited text no. 1
    
2.
D'Souza H, Kulkarni A. Coronavirus disease-2019 and systemic therapy for breast cancer. Cancer Res Stat Treat 2020;3:332-3.  Back to cited text no. 2
    
3.
Akram Hussain SM. Molecular-based screening and therapeutics of breast and ovarian cancer in low- and middle-income countries. Cancer Res Stat Treat 2020;3:81-4.  Back to cited text no. 3
  [Full text]  
4.
Thomas VM, Mathew A. Immunotherapy during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:149-50.  Back to cited text no. 4
    
5.
Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with cancer appear more vulnerable to SARS-COV-2: A multi-center study during the COVID-19 outbreak. Cancer Discov 2020. Available from: https://cancerdiscovery.aacrjournals.org/content/early/2020/04/29/2159-8290.CD-20-0422. [Last accessed on 2020 May 09].  Back to cited text no. 5
    
6.
Bonomi L, Ghilardi L, Arnoldi E, Tondini CA, Bettini AC. A rapid fatal evolution of Coronavirus Disease-19 (COVID-19) in an advanced lung cancer patient with a long time response to nivolumab. J Thorac Oncol 2020. pii: S1556-0864(20)30285-9.  Back to cited text no. 6
    
7.
Menon N, Noronha V, Joshi A, Patil V, Prabhash K. Systemic therapy for thoracic malignancies during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:29-34.  Back to cited text no. 7
    




 

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