|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 334
Authors' reply to D'Souza et al.
Santosh Kumar Chellapuram, Ajay Gogia
Department of Medical Oncology, Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||10-May-2020|
|Date of Decision||11-May-2020|
|Date of Acceptance||11-May-2020|
|Date of Web Publication||19-Jun-2020|
Department of Medical Oncology, Dr. B.R.A. Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chellapuram SK, Gogia A. Authors' reply to D'Souza et al. Cancer Res Stat Treat 2020;3:334
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. 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., 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. 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. 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. 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., 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. that with time, we will be better equipped with more robust data in guiding our patients rationally.
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Conflicts of interest
There are no conflicts of interest.
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