Managing RCC treatment during COVID-19: ‘Use your best judgement’
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The COVID-19 pandemic presents unique challenges to renal cell carcinoma patients, especially concerning treatment. Healio spoke with Matthew R. Zibelman, MD, assistant professor, department of hematology/oncology, Fox Chase Cancer Center, about renal cell carcinoma treatment during the COVID-19 pandemic, the FDA approval of pembrolizumab and use of telemedicine.
Healio: What does treatment look like during the COVID-19 pandemic for patients with renal cell carcinoma, and what are adjustments physicians have had to make for their patients?
Zibelman: For the metastatic patients that we primarily treat, treatment changes depend on the patient. Patients on observation or stable oral therapy have been often able to transition more follow-ups to telemedicine visits. Many of their side effects can be managed with local labs and discussion with visual exam only.
Patients receiving infusional immunotherapy decide with their physicians whether therapy should be continued at the usual schedule or held or delayed, and this is often decided on a patient-by-patient basis.
One helpful change that has coincided with this timing is the FDA approval of pembrolizumab (Keytruda, Merck) every 6 weeks as opposed to the previous dosing every 3 weeks. This allows patients on that drug in combination with axitinib (Inlyta, Pfizer) to come less frequently and limit exposure. For patients who have been stable or responding to immunotherapy, skipping or delaying doses may often be a reasonable option given the long half-life and lasting effect of these drugs.
Healio: How have patients responded to alterations in their treatment?
Zibelman: Generally, most patients have been very willing to accept changes in their usual care, especially the addition of telemedicine which can meet their needs without disrupting their schedules and minimizing their infection risk.
Healio: Are patients with renal cell carcinoma at higher risk for COVID-19?
Zibelman: Not that we know of. Fortunately, we don't use any immunosuppressive therapies in RCC so that is not a factor. Many patients with RCC may be older and have other co-morbidities that put them at risk, but their RCC itself is not a risk factor.
There has been some data suggesting patients receiving immunotherapy might be at some increased risk, but at this point I do not think we definitively know that this is true, and patients who require this therapy should continue.
Healio: What do physicians need to know about managing patient treatment at this time?
Zibelman: Physicians need to use their best judgement to guide patients about the risks and benefits of continuing or delaying therapy because of COVID19 risk. This may depend on many factors, including location, other comorbidities, age, etc.
Patients with mRCC have incurable disease, so those who need to continue palliative therapy to maintain quantity and quality of life may very well benefit from continuing therapy in spite of the risk, though some who are doing well may choose to delay or forgo treatment.
A frank discussion with patients on an individualized basis is the key.
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