Because so little was known about coronavirus at the start of the pandemic, there was a lot of discussion between healthcare professionals about the best way to manage cancer patients with the threat of infection with the virus. In recent years, immune checkpoint inhibitors have become standard of care for most metastatic renal cell carcinoma (RCC) patients. Doctors were not sure whether these treatments should be modified in response to the COVID-19 pandemic.
A recent online survey of 41 doctors revealed that for the majority (73%), RCC risk category (poor, intermediate or favourable) and patient fitness were the two most important factors for decision-making. During the pandemic, immune checkpoint inhibitors were chosen less often in favour of a tyrosine kinase inhibitor (TKI), mainly sunitinib or pazopanib. The use of ipilimumab/nivolumab for fit patients with intermediate/poor-risk RCC halved during the pandemic and more TKIs were given. In patients who were responding to combinations with TKIs or another immune checkpoint inhibitor, treatment regimens were modified by extending cycle length, or suspending one or even both immune checkpoint inhibitors.
In conclusion, modifications of the treatment of metastatic RCC during the coronavirus pandemic were variable, with most doctors changing treatments from immune checkpoint inhibitor combinations to combinations with a TKI or a TKI alone.