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Impact of COVID-19 pandemic on treatment patterns in metastatic clear cell renal cell carcinoma

Stefanie Aeppli, Eric Innocents Eboulet, Tim Eisen, Bernard Escudier, Stefanie Fischer, James Larkin, Viktor Gruenwald, David McDermott, Jan Oldenburg, Aurelius Omlin, Camillo Porta, Brian Rini, Manuela Schmidinger, Cora Sternberg & Christian Rothermundt

abstract

BACKGROUND
The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic.

METHODS
We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19.

FINDINGS
For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both.

CONCLUSION
mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy.
   
citation Aeppli S, Eboulet E I, Eisen T, Escudier B, Fischer S, Larkin J, Gruenwald V, McDermott D, Oldenburg J, Omlin A, Porta C, Rini B, Schmidinger M, Sternberg C, Rothermundt C. Impact of COVID-19 pandemic on treatment patterns in metastatic clear cell renal cell carcinoma. ESMO Open 2020; 5:.
   
type journal paper/review (English)
date of publishing 2020
journal title ESMO Open (5/Suppl 3)
ISSN electronic 2059-7029
PubMed 32669298
DOI 10.1136/esmoopen-2020-000852