Oncology Unit, Ospedale del Mare, Napoli, Campania, Italy.
Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II and CRCTR Coordinating Rare Tumors Reference Center of Campania Region, AOU Federico II, Napoli, Italy.
J Immunother Cancer. 2020 Oct;8(2). doi: 10.1136/jitc-2020-001154.
The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region.
This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2-positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher's exact tests for dichotomous answers and χ test for trends relative to the questions with 3 or more options.
This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2-positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients' planned treatment approach). The results from responders in Campania did not differ significantly from the national ones.
Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.
2019 年冠状病毒病（COVID-19）大流行使全球卫生系统不堪重负。关于 COVID-19 对接受或候选免疫检查点抑制剂（ICI）治疗的癌症患者（CPs）的影响的数据尚缺乏。我们描述了在 COVID-19 大流行期间，对有资格接受或正在接受 ICI 治疗的实体瘤患者的管理实践和调整，特别关注坎帕尼亚地区。
这项由 SCITO（坎帕尼亚肿瘤免疫治疗协会）小组青年分会发起的调查（25 个问题），在意大利各地受到 COVID-19 不同程度影响的年轻肿瘤学家中进行了传播：高（第 1 组）、中（第 2 组）和低（第 3 组）SARS-CoV-2 阳性患者的流行率。对于坎帕尼亚地区，应答者分为在癌症中心（CC）、大学医院（UH）和综合医院（GH）工作的医生。使用 Fisher 确切检验比较意大利高（H）与中（M）组和低（L）组以及坎帕尼亚地区 CC、UH 和 GH 之间的百分比，对于具有 3 个或更多选项的问题，使用 χ 检验进行趋势比较。
这是意大利第一项调查 COVID-19 对癌症免疫治疗影响的研究，在其类型上是独一无二的，结果也非常明确。COVID-19 大流行似乎并未影响意大利 ICI 的处方和使用标准。远程医疗得到了广泛应用。大多数应答者倾向于在 SARS-CoV-2 阳性患者中中断免疫治疗，并采用更长时间间隔的 ICI。大多数应答者倾向于不延迟 ICI 的开始；支持性治疗没有改变，但一些医生选择延迟手术（如果是患者计划治疗方法的一部分）。坎帕尼亚地区应答者的结果与全国结果没有显著差异。
我们的研究强调了意大利肿瘤学家为接受 ICI 治疗的 CPs 保持高标准护理所做的努力，无论 COVID-19 在该地区的流行率如何，这表明采用了类似的解决方案。对接受 ICI 治疗并经历 COVID-19 的患者的研究将阐明继续治疗的安全性概况，从而为最合适的临床行为提供信息。
