Treatment Guidance for Patients With Lung Cancer During the Coronavirus 2019 Pandemic

Abstract

The global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer seems to be higher, especially as they are more likely to present with an immunocompromised condition, either from cancer itself or from the treatments they receive. A major consideration in the delivery of cancer care during the pandemic is to balance the risk of patient exposure and infection with the need to provide effective cancer treatment. Many aspects of the SARS-CoV-2 infection currently remain poorly characterized and even less is known about the course of infection in the context of a patient with cancer. As SARS-CoV-2 is highly contagious, the risk of infection directly affects the cancer patient being treated, other cancer patients in close proximity, and health care providers. Infection at any level for patients or providers can cause considerable disruption to even the most effective treatment plans. Lung cancer patients, especially those with reduced lung function and cardiopulmonary comorbidities are more likely to have increased risk and mortality from coronavirus disease 2019 as one of its common manifestations is as an acute respiratory illness. The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas. It is expected that firmer recommendations can be developed as more evidence becomes available.

Keywords: COVID-19; Lung cancer; Patient care; SARS-CoV-2.

Figure 1

This is a scanning electron microscope image, which shows severe acute respiratory syndrome coronavirus 2 (round blue objects) emerging from the surface of cells cultured in the laboratory. Severe acute respiratory syndrome coronavirus 2, also known as 2019 novel coronavirus, is the virus that causes coronavirus disease 2019. The virus exhibited here was isolated from a patient in the United States. Adapted from National Institute of Allergy and Infectious Diseases - Rocky Mountain Laboratories (NIAID-RML).

Figure 2

(A) Early stage COVID-19 CT findings: axial CT image of the lungs of a 67-year-old Italian man presenting with hemoptysis. This CT image exhibits a left upper lobe mass (arrowhead) histologically proven to be adenocarcinoma. There are also peripheral, subpleural GGOs (arrowed) and the patient was confirmed on second throat RT-PCR swab test to also have COVID-19. (B) Progressive stage COVID-19 CT findings: reconstructed axial lung image from a CT-PET scan done for the same patient 2 days later, which exhibited progression of the GGOs into areas of crazy paving (arrows) and consolidation (arrowheads). COVID-19, coronavirus disease 2019; CT, computed tomography; GGOs, ground-glass opacities; PET, positron emission tomography; RT-PCR, reverse transcription–polymerase chain reaction.

Figure 3

Peak stage COVID-19 CT findings: axial CT images of the mediastinum (A) and lungs (B) of a 54-year-old Chinese man on day 13 of onset of symptoms exhibiting large bilateral pleural effusions with dense dependent consolidation at the lower lobes (arrows). Trivial pericardial effusion is also seen (arrowhead). Partially imaged ECMO catheter overlying the right anterior chest wall. COVID-19, coronavirus disease 2019; CT, computed tomography; ECMO, extracorporal membrane oxygenation.

Figure 4

(A) Axial CT lung image of a 73-year-old Chinese woman with EGFR-positive NSCLC 2 months after starting a third-generation EGFR-TKI. The upper lobes do not reveal any abnormality. (B) Axial CT lung image of the same patient 4 months after starting a third-generation EGFR-TKI. The upper lobes now reveal patchy ground-glass changes (arrows) with interstitial thickening (arrowheads) in a perihilar distribution consistent with EGFR-TKI–induced pneumonitis. CT, computed tomography; TKI, tyrosine kinase inhibitor.