Systemic treatment of advanced/metastatic renal cell carcinoma in the context of SARS-CoV-2 pandemic: recommendations fr
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LETTER TO THE EDITOR
Systemic treatment of advanced/metastatic renal cell carcinoma in the context of SARS‑CoV‑2 pandemic: recommendations from the interdisciplinary working group for renal tumors (IAG‑N) Philipp Ivanyi1,2 · Carsten Grüllich3 · Nils Kroeger4,5 · Thomas Gauler6 · Manfred Johannsen7 · Jens Bedke8 · Viktor Grünwald9 · On behalf of the Interdisciplinary working group on renal tumors (IAG-N) of the German Cancer Socity (DKG) Received: 28 June 2020 / Accepted: 28 July 2020 © The Author(s) 2020
Abstract This letter summarizes recommendations from the interdisciplinary working group of renal tumors (IAGN) of the German Cancer Society for the systemic treatment of advanced/metastatic renal cell carcinoma in the context of the current SARSCoV-2 pandemic
Background During the SARS-CoV-2 pandemic, oncologists faced several new challenges (Jones et al. 2020; Hanna et al. 2020; Lai et al. 2020). Data on SARS-CoV-2 in cancer patients suggested outstanding rates of severe clinical courses (39–75%) and mortality (up to 29%) upon SARS-CoV-2 infection, although methodological limitations of these observations are of concern (Desai et al. 2020; Liang et al. 2020; Yang et al. 2020; Zhang et al. 2020). However, oncological therapies might raise SARS-CoV-2-related morbidity and mortality (Desai et al. 2020; Liang et al. 2020; Yang et al. 2020; Zhang et al. 2020). Checkpoint inhibitors (CPI) could Jens Bedke and Viktor Grünwald shared senior author * Jens Bedke [email protected]‑tuebingen.de
negatively interfere with the pathogenesis of SARS-CoV-2, and an overlap of symptoms of SARS-CoV-2 and cancer treatment related adverse events can be assumed which could result in a diagnostic challenge (Zhang et al. 2020; Bersanelli 2020; Rotz et al. 2017). In particular, interstitial pneumonia from SARS-CoV-2 cannot be differentiated from CPI-associated pneumonitis with certainty using CT images, and may present with overlapping features (Zhang et al. 2020; Bersanelli 2020). Pneumonitis in CPI-treated patients are rare with an incidence von 2–10% but accounts with treatment-related death rate of 35% (Wang et al. 2018; Naidoo et al. 2017). Effects of immune suppression due to supportive measure has also to be considered, although only preliminary data exist on effects of steroids in cancer patients during the SARS-CoV-2 pandemic (Yang et al. 5
Urologie-Altstadtquartier Magdeburg, Magdeburg, Germany
6
Department of Radiation Oncology, West German Cancer Center, University Hospital Essen of the University Duisburg-Essen, Essen, Germany
7
Urology and Urooncology Practice Berlin, Vice Chairman d-uo (Deutsche Uro-Onkologen), Berlin, Germany
8
Department of Urology, Eberhard Karls University Tuebingen, Hoppe‑Seyler‑Str. 3, 72076 Tübingen, Germany
9
Interdisciplinary Genitourinary Oncology, West‑German Cancer Center Essen Clinic for Medical Oncology and Clinic for Urology OZ1, University Hospital Essen (AöR), Room 2.073 Hufelandstraße 55, 45147 Essen, Germany
* Viktor Grünwald viktor.gruenwald@uk‑essen.de 1
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