NCCN Offers Guidance on Chemo Delays in COVID-Positive Patients

The National Comprehensive Cancer Network (NCCN) recently issued guidance on treating patients who have both a diagnosis of cancer and of COVID-19 – an extension and update of their previous guidance issued in April 2020.

“This new guidance, along with other expanding resources at NCCN.org/covid-19, will help to answer many of the treatment questions that have come up over the course of the pandemic. While specific to COVID-19 in cancer patients, the recommendations also provide useful information for COVID-19 infection management in individuals without cancer,” said Wui-Jin Koh, MD, chief medical officer of the NCCN in a statement.

Among the questions addressed are how cancer treatments may affect COVID-19 outcomes. The guidelines cite research findings that exposure to immunotherapy, hormonal therapy, or radiotherapy 1 month prior to SARS-CoV-2 infection had no correlation with increased mortality. However, findings on treatment with cytotoxic chemotherapy are a bit shakier – with some saying that being treated with that type of cancer agent can increase the risk of COVID-19 severity or death.

Patients who test positive for SARS-CoV2 should have their symptoms “be resolved or markedly improved before cytotoxic chemotherapy is administered,” the guidelines state, elaborating that treatment delays are dependent on durations of infectious viral shedding, severity of COVID-19 symptoms, cancer type and treatment, and risk of disease progression.

If a patient’s cancer is uncontrolled and their treatment is urgent, the care team should make a decision on whether or not they want to delay cytotoxic chemotherapy at all. Otherwise, the NCCN recommends the following for each patient group:

• Those with mild/moderate COVID-19 symptoms and non-hematologic cancers: Delay chemotherapy until the resolution of symptoms, and at least 10 days from symptom onset.
• Patients with severely symptomatic COVID-19 and/or hematologic malignancies: Delay chemotherapy until all symptoms are resolved and at least 20 days has passed since the onset of symptoms.
• Asymptomatic patients: Delay chemotherapy for at least 10 days after their first positive RT-PCR test, given that they stay asymptomatic. If a patient has been exposed to COVID-19 and is without symptoms, they should be monitored for symptoms for 14 days.
• Prior to planned hematopoietic cell transplantation or CAR T-cell therapy: Delay procedures for at least 10 days after symptom onset. Then, continue treatment as long as there is a significant improvement of COVID-19 symptoms.

“These recommendations for the simultaneous treatment of both COVID-19 and cancer synthesize contemporary guidelines from other specialty societies and organizations, along with rapidly emerging data,” Koh said.