ABSTRACT
Introduction & Objectives: Multidisciplinary tumor boards (MTBs) play a pivotal role in patients’ clinical management and decision-making process. Main barriers to achieve efficient MTBs, are lack of time and geographical distance. COVID-19 pandemic represented an exceptionalobstacle. Telehealth practice has recently expanded including live video conferences and remote patient visit. The elaboration of an efficient virtual(v)MTB during COVID-19 pandemic is a need and a key-point to realize a successful oncology team and to increase a network among healthprofessionals and institutions. Objective of the study was to assess the mode of operating of our vTMB and to evaluate satisfaction and concernsof participating physicians through a dedicated survey.Materials & Methods: A project for a virtual multi-institutional uro-oncological MTB was activated in Sicily. The vMTB was structured according to aBowen framework method, employing a cloud-based virtual platform (Navify®). A 5-point Likert scale measured acceptability, appropriateness, andfeasibility of the instrument. Consensus on patients’management was voted electronically and approved if at least 75% of consensus was reached.Decisions were matched to recent medical literature and verified as adhering to the guidelines. After the first 3 months of activity a structured surveywas carried out among the members of the vMTB to investigate their satisfaction, adherence and concerns.Results: The vMTB started in September 2020. Up to the end of December 2020, 13 virtual meetings (60-90 min each) were holded and 77cases of urological tumors were discussed. Overall, 18 hospital units and 48 specialists joined the meetings. The survey conducted among the 48participating physicians, positively highlighted the impact of the project: 48 (100%) preferred virtual to in-person MTB, 44 (91%) were satisfied ofthe quality of clinical information;46 (96%) on equity of care;42 (88%) on collaboration among specialists;42 (88%) on method standardizationand 37 (77%) on data security, tracking, storage, and availability.Conclusions: vMTB represents a unique opportunity to optimize multidisciplinary patient management. Our experience shows a rapid adaptation of physicians to vMTB. However, legal and technical issues remain fields of concern and must be carefully checked. Acknowledgments: Thanks to the GSTU foundation for Technical and Editing support
ABSTRACT
OBJECTIVE: The outbreak of coronavirus disease 2019 (COVID-19) has affected the treatment of cancer patients, with particular regard to the management of both chemotherapy and side effects. Chemotherapy-induced nausea and vomiting (CINV) are amongst the most troublesome side effects that impair patients' adherence to treatments and their quality of life (QoL). NEPA (Akynzeo®), is an oral fixed-dose combination of netupitant [a neurokinin-1 receptor antagonist (NK1RA), 300 mg] and palonosetron [(5-hydroxytryptamine (serotonin or 5HT) type3 receptor antagonist (5HT3RA), 0.5 mg] which has been shown to be effective in preventing CINV. PATIENTS AND METHODS: This prospective study started before the outbreak of COVID-19 and was carried out during the pandemic period. The aim was to evaluate the efficacy and safety of a single oral dose NEPA plus 12 mg of dexamethasone (DEX) in patients treated with Folfoxiri plus Bevacizumab and Folfirinox. The patients were diagnosed with advanced colorectal cancer (CRC) or advanced pancreatic ductal adenocarcinoma (PDAC). They were divided into two groups: naïve patients and patients previously treated with serotonin receptor antagonists (5HT3-RA) and neurokin-1 receptor antagonists (NK1-RA). RESULTS: During the overall phase, the complete response (CR) rate was 96.8% in naïve patients treated with Folfoxiri plus Bevacizumab, and 94.6% in patients treated with Folfirinox. During the acute and delayed phases, the CR rate was 92.8% and 94.2%, with Folfoxiri and Bevacizumab, as well as 96.2% and 94.6%, with Folfirinox. There was no adequate control of CINV events in patients on antiemetic prophylaxis with 5HT3-RA or NK1-RA associated with cortisone. During the overall phase, the CR rate was 74.6% with Folfoxiri plus Bevacizumab and 75.8% with Folfirinox. During the acute and delayed phases, the CR rate was 72.5% and 74.8% with Folfoxiri plus Bevacizumab, as well as 75.2% and 74.6% with Folfirinox. CONCLUSIONS: This study has shown the therapeutic benefits of NEPA in the management and prophylaxis of CINV events, both in naive patients and patients previously treated with 5HT3-RA and NK1-RA. In addition, NEPA has been shown to be safe, both before and during the COVID-19 pandemic.