A recent online survey involving 41 kidney cancer experts worldwide looked at the changes made to their clinical practice for the treatment of metastatic renal cell carcinoma (RCC) during the COVID-19 pandemic.
The majority of the experts prescribed immunotherapy combination treatment for untreated metastatic RCC patients. The survey showed an increase in the use of targeted therapies and a shift from immunotherapy/immunotherapy combinations to immunotherapy/targeted-therapy combinations during the pandemic.
Most of the experts (73%) mentioned that a combination of the risk-factor (favourable, intermediate or poor) for the patient and the patient’s fitness were the two most important factors for decision-making. For favourable risk patients, immune checkpoint inhibitors were prescribed less often and substituted for TKIs, mainly sunitinib or pazopanib during the pandemic. In fit, intermediate- or poor-risk patients over 80% of experts prescribed ipilimumab/nivolumab before the pandemic, in contrast to only 41% during COVID-19; instead, more TKIs were given. In patients responding to immunotherapy combinations or immunotherapy/TKI combinations treatments were modified by extending the cycle length and withholding one or even both immunotherapies.
It is unclear whether active cancer treatment with immunotherapy impacts the risk or outcomes of COVID-19 infection. This survey provides information for oncologists on the treatment selection in metastatic RCC during the pandemic. The experts propose a careful decision-making process for every individual patient, weighing all short-term and long-term pros and cons of treatment during the COVID-19 pandemic.