COVID-19 epidemic: Proposed alternatives in the management of digestive cancers: A French intergroup clinical point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR)

Frederic Di Fiore, Olivier Bouché, Come Lepage, David Sefrioui, Alice Gangloff, Lilian Schwarz, Jean Jacques Tuech, Thomas Aparicio, Thierry Lecomte, Camille Boulagnon-Rombi, Astrid Lièvre, Sylvain Manfredi, Jean Marc Phelip, Pierre Michel, Thésaurus National de Cancérologie Digestive (TNCD), Société Nationale Française de Gastroentérologie (SNFGE), Fédération Francophone de Cancérologie Digestive (FFCD), Groupe Coopérateur multidisciplinaire en Oncologie (GERCOR), Fédération Nationale des Centres de Lutte Contre le Cancer (UNICANCER), Société Française de Chirurgie Digestive (SFCD), Société Française d'Endoscopie Digestive (SFED), Société Française de Radiothérapie Oncologique (SFRO) and Société Française de Radiologie (SFR), Association Chirurgie Hepato-Biliaire et Transplantation (ACHBT), Frederic Di Fiore, Olivier Bouché, Come Lepage, David Sefrioui, Alice Gangloff, Lilian Schwarz, Jean Jacques Tuech, Thomas Aparicio, Thierry Lecomte, Camille Boulagnon-Rombi, Astrid Lièvre, Sylvain Manfredi, Jean Marc Phelip, Pierre Michel, Thésaurus National de Cancérologie Digestive (TNCD), Société Nationale Française de Gastroentérologie (SNFGE), Fédération Francophone de Cancérologie Digestive (FFCD), Groupe Coopérateur multidisciplinaire en Oncologie (GERCOR), Fédération Nationale des Centres de Lutte Contre le Cancer (UNICANCER), Société Française de Chirurgie Digestive (SFCD), Société Française d'Endoscopie Digestive (SFED), Société Française de Radiothérapie Oncologique (SFRO) and Société Française de Radiologie (SFR), Association Chirurgie Hepato-Biliaire et Transplantation (ACHBT)

Abstract

Introduction: Patients treated for malignancy are considered at risk of severe COVID-19. This exceptional pandemic has affected countries on every level, particularly health systems which are experiencing saturation. Like many countries, France is currently greatly exposed, and a complete reorganization of hospitals is ongoing. We propose here adaptations of diagnostic procedures, therapies and care strategies for patients treated for digestive cancer during the COVID-19 epidemic.

Methods: French societies of gastroenterology and gastrointestinal (GI) oncology carried out this study to answer two main questions that have arisen (i) how can we limit high-risk situations for GI-cancer patients and (ii) how can we limit contact between patients and care centers to decrease patients' risk of contamination while continuing to treat their cancer. All recommendations are graded as experts' agreement according to the level of evidence found in the literature until March 2020.

Results: A proposal to adapt treatment strategies was made for the main GI oncology situations. Considering the level of evidence and the heterogeneous progression of the COVID-19 epidemic, all proposals need to be considered by a multidisciplinary team and implemented with patient consent.

Conclusion: COVID-19 epidemic may significantly affect patients treated for digestive malignancies. Healthcare teams need to consider adapting treatment sequences when feasible and according to the epidemic situation.

Keywords: COVID-19 infection; Chemotherapy; Digestive cancer; French Clinical Practice Guidelines; Surgery.

Conflict of interest statement

Conflict of interest The Authors have no Conflict of interest in digestive oncology topics with COVID-19.

Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

References

    1. Kim Y.J., Lee E.S., Lee Y.S. High mortality from viral pneumonia in patients with cancer. Infect Dis. 2019;51:502–509.
    1. Chen N., Zhou M., Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513.
    1. Wu C., Chen X., Cai Y., et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med doi 10.1001/jamainternmed.2020.0994
    1. Liang W., Guan W., Chen R., et al. Cancer patients in SARS-CoV -2 infection: a nationwide analysis in China. Lancet Oncol10.1016/S1470-2045(20)30096-6
    1. Spinelli A., Pellino G. COVID-19 pandemic: perspectives on an unfolding crisis. Br J Surg. 2020 doi: 10.1002/bjs.11627.
    1. Zhang Y., Xu J.M. Medical diagnosis and treatment strategies for malignant tumors of the digestive system during the outbreak of novel coronavirus pneumonia. Zhonghua Zhong Liu Za Zhi. 2020 Feb 29;42(0):E005.
    1. Luo Y., Zhong M. Standardized diagnosis and treatment of colorectal cancer during the outbreak of novel coronavirus pneumonia in Renji hospital. Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Feb 22;23(3):E003. doi: 10.3760/cma.j.cn441530-20200217-00057.
    1. Chen Y.H., Peng J.S. Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China. Zhonghua Wei Chang Wai Ke Za Zhi. 25 Feb 2020;23(2) doi: 10.3760/cma.j.issn.1671-0274.2020.02.001. I–IV.
    1. Tuech J.J., Gangloff A., DI Fiore F., Michel P., Brigand C., Slim K. Strategy for the practice of digestive and oncologic surgery in COVID 19 epidemic. J Visc Surg. 2020 doi: 10.1016/j.jviscsurg.2020.03.008.
    1. Henwood A.F. Coronavirus disinfection in histopathology. J Histotechnol. 2020 Mar 1:1–3.
    1. Lefevre J.H., Mineur L., Kotti S. Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer. J Clin Oncol. 2016;34:3773–3780.
    1. Erlandsson J., Holm T., Pettersson D. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol. 2017;18:336–346.
    1. Renehan A.G., Malcomson L., Emsley R. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol. 2016;17:174–183.
    1. Rullier E., Rouanet P., Tuech J.J. Organ preservation for rectal cancer (GRECCAR 2):a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet. 2017;390:469–479.
    1. Karoui M., Rullier A., Piessen G. Perioperative FOLFOX 4 versus FOLFOX 4 Plus Cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a phase ii multicenter randomized controlled trial (PRODIGE 22) Ann Surg. 2019 doi: 10.1097/SLA.0000000000003454.
    1. Foxtrot collaborative group Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol. 2012;13:1152–1160.
    1. Andre T., de Gramont A., Vernerey D. Adjuvant Fluorouracil, leucovorin, and oxaliplatin in stage II to III colon cancer: updated 10-year survival and outcomes according to BRAF mutation and mismatch repair status of the MOSAIC study. J Clin Oncol. 2015;33:4176–4187.
    1. Maughan T.S., Adams R.A., Smith C.G. Addition of cetuximab to oxaliplatin-based fi rst-line combination chemotherapy for treatment of advanced colorectal cancer: results of the randomised phase 3. MRC COIN trial. Lancet. 2011;377:2103–2114.
    1. Simkens L.H.J., van Tinteren H., May A., et al. Maintenance treatment with capecitabine and bevacizumab in metastatic colorectal cancer (CAIRO3): a phase 3 randomised controlled trial of the Dutch Colorectal Cancer Group. Lancet2105; 385:1843-52
    1. Bekaii-Saab T.S., Ou F.S., Ahn D.H. Regorafenib dose-optimization in patients with refractory metastatic colorectal cancer (ReDOS): a randomised, multicenter, open-label, phase 2 study. Lancet Oncol. 2019;20:1070–1082.
    1. Mayer R.J., Van Cutsem E., Falcone A. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015;372 1909e19.
    1. Conroy T., Hammel P., Hebbar M. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. New Engl J Med. 2018;379:2395–2406.
    1. Kim S.T., Kang J.H., Lee J. Capecitabine plus oxaliplatin versus gemcitabine plus oxaliplatin as first-line therapy for advanced biliary tract cancers: a multicenter, open-label, randomized, phase III, noninferiority trial. Ann Oncol. 2019;30(5):788–795.
    1. Al-Batran S.E., Homann N., Pauligk C. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393:1948–1957.
    1. Mariette C., Dahan L., Mornex F. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;32:2416–2422.
    1. Meulendijks D., Dewit L., Tomasoa N.B. Chemoradiotherapy with capecitabine for locally advanced anal carcinoma: an alternative treatment option. Br J Cancer. 2014;111:1726–1733.
    1. Vezzosi D., Walter T., Laplanche A. Chromogranin A measurement in metastatic well-differentiated gastroenteropancreatic neuroendocrine carcinoma: screening for false positives and a prospective follow-up study. Int J Biol Mark. Apr-Jun 2011;26(2):94–101.
    1. Iwanicki-Caron I., Di Fiore F., Roque I. Usefulness of the serum carcinoembryonic antigen kinetic for chemotherapy monitoring in patients with unresectable metastasis of colorectal cancer. J Clin Oncol. 2008;26:3681–3686.
    1. Laurent L., Sefrioui D., Bignon A.L. CA19.9 decrease >15% is a predictor of favourable outcome in patients treated for advanced pancreatic carcinoma: analysis of two independent cohorts. HPB. 2019;21:582–588.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren