Due to the volatility of COVID-19 landscape, there’s a plethora of information regarding the virus that is still left unknown; particularly with regards to recovery, transmission, immunization, and its relationship with other conditions. According to our current understanding, even though lung cancer patients are not more susceptible to contracting the virus, there exists a much higher likelihood of complications arising due to their pre-existing disease if infected. This is why patients with respiratory diseases, specifically those with ailments like lung cancer and COPD, should be considered at “higher risk” of COVID-19 and should be advised to take the necessary precautions.
Despite the gravity of COVID-19 on both patients and the medical system in general, efforts in finding new cures and treatments for lung cancers have remained persistent. Researchers at this year’s World Conference on Lung Cancer (WCLC) announced findings regarding treatments for ALK-positive lung cancer and mesothelioma cancer, showing new promising results for patients with these conditions. For mesothelioma patients specifically, the FDA recently approved Atara Biotherapeutics for a phase 1 trial, which will focus on CAR T-cell therapy treatment for patients with an advanced mesothelioma diagnosis. Although multiple trials are ongoing, staying up-to-date on all types of cancer studies can help guide patients as the world continues to navigate COVID-19.
Chemo and Lung Patients:
As chemotherapy affects the body’s ability and reserves to mount an immune response to fight infections, many patients may have concerns over that side effect in regards to COVID-19. The way radiation treatment interacts with COVID-19 is still currently unknown. However, since undergoing an immunosuppressive treatment degrades the body’s ability to fight infections, chemotherapy should be assumed to be a risk factor for patients in developing the more severe effects of COVID-19.
Lung Cancer surgeries
Patients with stage I tumors measuring less than 1.5 cm should be able to defer their surgery for several weeks if there are concerns over infections. Patients with stage II and III tumors should be assessed on a more case-by-case basis taking into account both the individual’s health, and hospital’s proper staffing and resources. In some cases, stage III patients may be able to be treated nonoperatively through oral medication. A history of surgery could mean fewer pulmonary reserves reducing the maximum amount of air the lungs can inhale, and may generally increase the risk of those infected.
Cancer drug shortages
Physicians and medical professionals alike may have concerns over the current drug shortages–as of right now, there are no concerns surrounding shortages in cancer drugs specifically. Physicians should still regularly refer to the FDA’s ongoing database of drug shortages to be completely sure. The CDC recommends that patients should receive an advance supply of supplemental medications in case individuals are unable to refill their prescription due to COVID-19 related issues. A plan should be put in place ahead of time to prevent this from happening depending on both the type of medication and the patient’s insurance.
Clinical trial protocols
According to the FDA, changes may be made to the clinical trial protocol without prior review or approval, but only if it is intended to safeguard the life and health of the patient(s). One example being the implementation of telehealth to monitor the patient in lieu of on-site visits (if approved by an IRB). The FDA can then be notified of the changes made. However, as routine monitoring such as blood tests and heart function exams are currently unable to be conducted through telehealth visits, the patient’s clinical trial team and the trial sponsor(s) should have an already instituted strategy to ensure the safety of the patient is prioritized.
Lung Cancer and COVID-19 research
In a study done by the Memorial Sloan Kettering Cancer Center, 62% of the 102 lung cancer patients surveyed ended up hospitalized from COVID-19, with a 25% mortality rate. The study concluded that specific tumor characteristics, those being the presence of metastatic vs active lung cancer or history of thoracic radiation/surgery, did not appear to affect the intensity of COVID-19. An additional study through the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) registry found that out of 200 patients with both COVID-19 and some form of thoracic cancer, 76% were hospitalized and 33% had died pointing to similar numbers as MSKCC.
As information surrounding COVID-19 becomes more readily available, medical professionals need to stay alert in order to relay sufficient information to their patients as quickly as possible. Knowledge is an incredibly strong tool, and continues to prove how invaluable it is time and time again throughout the COVID-19 pandemic.