Perception and attitudes of Italian physicians towards the management of checkpoint inhibitors in oncology during COVID-19 outbreak: Results from a national survey

ABSTRACT

Background: During the COVID-19 outbreak oncological care has been reorganized to face the emergency. Cancer patients have been reported to be at higher risk of severe events related to SARS-CoV-2. Moreover, there are concerns of a possible interference between immune checkpoint inhibitors (ICIs) and the pathogenesis of the infection. Methods: A 22-item questionnaire was shared with Italian physicians managing ICIs, between May 6 and 16, 2020. This survey aimed at exploring the perception about SARS-CoV-2 related risks in cancer patients receiving ICIs, and whether the management of these patients has been modified during COVID-19 outbreak. Results: Respondents were 104, with a median age of 35.5 years, mainly females (58.7%), mainly working in Northern Italy (71%). 47.1% of respondents were afraid that a synergism could exist between ICIs mechanism of action and SARS-CoV-2 pathogenesis, leading to worse outcomes. 97.1% of respondents would not deny an ICI only for the possible occurrence of COVID-19. Measures for reducing hospital visits have been adopted by choosing the ICIs schedule with fewer administrations, adopting the highest labeled dose of each drug (55.8%) and/or choosing, among different ICIs for the same indication, the one with the longer interval between cycles (30.8%). 53.8% of respondents suggested the need to test for SARS-CoV-2 every cancer patient candidate to ICIs. Regarding differential diagnosis between immune-related adverse events (irAEs) and COVID-19 manifestations, 71.2% of respondents declared to manage a patient with onset of dyspnea and cough like a COVID-19 patient until otherwise proven (ie, waiting for the result of SARS-CoV-2 test before doing other diagnostic or therapeutic procedures);however, 96.2% did not reduce the use of steroids to manage irAEs during the pandemic. No major impact of COVID-19 on physicians’ attitudes towards the use of ICIs to manage specific clinical situations in different cancer types (ie, lung, breast, melanoma, urothelial) was observed. Conclusions: These results highlight the uncertainty of physicians dealing with ICIs in cancer patients during COVID-19 outbreak, supporting the need of dedicated studies on this regard. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure M. Tagliamento Travel/Accommodation/Expenses Roche, Bristol-Myers Squibb, Astra Zeneca, Takeda. F. Poggio Travel/Accommodation/Expenses Takeda, Ely Lilly;Honoraria (self) Merck Sharp & Dohme, Ely Lilly, Novartis. L. Del Mastro Honoraria (self) Roche, Pfeizer, Ipsen, Eli Lilly, Novartis, Takeda, Merck Sharp & Dohme, Genomic Health, Seattle Genetics;Non-remunerated activity/ies Celgene. M. Di Maio Advisory/Consultancy Eisai, Takeda, Janssen, Astellas, Pfizer, AstraZeneca. M. Lambertini Advisory/Consultancy Roche and Ely Lilly;Speaker Bureau/Expert testimony Roche, Takeda and Theramex. All other authors have declared no conflicts of interest.