Impact of COVID-19 outbreak on cancer immunotherapy in Italy: a survey of young oncologists
Authors: Ottaviano Margaret , Curvietto Marcello , Rescigno Pasquale , Tortora Marianna , Palmieri Giovannella , Giannarelli Diana , Aieta Michele , Assalone Pasquale , Attademo Laura , Avallone Antonio , Bloise Francesco , Bosso Davide , Borzillo Valentina , Buono Giuseppe , Calderoni Giuseppe , Caputo Francesca , Cartenì Giacomo , Cavallero Diletta , Cavo Alessia , Ciardiello Fortunato , Conca Raffaele , Conteduca Vincenza , De Falco Stefano , De Felice Marco , De Laurentiis Michelino , De Placido Pietro , De Placido Sabino , De Santo Irene , De Stefano Alfonso , Della Corte Carminia Maria , Di Franco Rossella , Di Lauro Vincenzo , Fabbrocini Antonietta , Federico Piera , Festino Lucia , Giordano Pasqualina , Giuliano Mario , Gridelli Cesare , Grimaldi Antonio Maria , Lia Michela , Marretta Antonella Lucia , Massa Valentina , Mennitto Alessia , Merler Sara , Merz Valeria , Messina Carlo , Messina Marco , Milano Monica , Minisini Alessandro Marco , Montesarchio Vincenzo , Morabito Alessandro , Morgillo Floriana , Mucci Brigitta , Nappi Lucia , Napolitano Fabiana , Paciolla Immacolata , Pagliuca Martina , Palmieri Giuseppe , Parola Sara , Pepe Stefano , Petrillo Angelica , Piantedosi Francovito , Piccin Luisa , Picozzi Fernanda , Pietroluongo Erica , Pignata Sandro , Prati Veronica , Riccio Vittorio , Rosanova Mario , Rossi Alice , Russo Anna , Salati Massimiliano , Santabarbara Giuseppe , Sbrana Andrea , Simeone Ester , Silvestri Antonia , Spada Massimiliano , Tarantino Paolo , Taveggia Paola , Tomei Federica , Vincenzo Tortora , Trapani Dario , Trojanello Claudia , Vanella Vito , Vari Sabrina , Ventriglia Jole , Vitale Maria Grazia , Vitiello Fabiana , Vivaldi Caterina , von Arx Claudia , Zacchi Francesca , Zampiva Ilaria , Zivi Andrea , Daniele Bruno , Ascierto Paolo Antonio 
Published: October 2020

Background

The coronavirus disease 2019 (COVID-19) pandemic has overwhelmed the health systems worldwide. Data regarding the impact of COVID-19 on cancer patients (CPs) undergoing or candidate for immune checkpoint inhibitors (ICIs) are lacking. We depicted the practice and adaptations in the management of patients with solid tumors eligible or receiving ICIs during the COVID-19 pandemic, with a special focus on Campania region.

Methods

This survey (25 questions), promoted by the young section of SCITO (Società Campana di ImmunoTerapia Oncologica) Group, was circulated among Italian young oncologists practicing in regions variously affected by the pandemic: high (group 1), medium (group 2) and low (group 3) prevalence of SARS-CoV-2–positive patients. For Campania region, the physician responders were split into those working in cancer centers (CC), university hospitals (UH) and general hospitals (GH). Percentages of agreement, among High (H) versus Medium (M) and versus Low (L) group for Italy and among CC, UH and GH for Campania region, were compared by using Fisher’s exact tests for dichotomous answers and χ2 test for trends relative to the questions with 3 or more options.

Results

This is the first Italian study to investigate the COVID-19 impact on cancer immunotherapy, unique in its type and very clear in the results. The COVID-19 pandemic seemed not to affect the standard practice in the prescription and delivery of ICIs in Italy. Telemedicine was widely used. There was high consensus to interrupt immunotherapy in SARS-CoV-2–positive patients and to adopt ICIs with longer schedule interval. The majority of the responders tended not to delay the start of ICIs; there were no changes in supportive treatments, but some of the physicians opted for delaying surgeries (if part of patients’ planned treatment approach). The results from responders in Campania did not differ significantly from the national ones.

Conclusion

Our study highlights the efforts of Italian oncologists to maintain high standards of care for CPs treated with ICIs, regardless the regional prevalence of COVID-19, suggesting the adoption of similar solutions. Research on patients treated with ICIs and experiencing COVID-19 will clarify the safety profile to continue the treatments, thus informing on the most appropriate clinical conducts.