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Coronavirus (COVID-19): Interim cancer treatment options

Published: 9 Jun 2020
Last updated: 12 Oct 2020 - see all updates

Interim treatment options during the COVID-19 pandemic supported by the COVID-19 National Cancer Medicines Advisory Group.

Published:
9 Jun 2020
Coronavirus (COVID-19): Interim cancer treatment options

The COVID-19 pandemic changes the balance of benefit to risk for patients receiving systemic anticancer therapy (SACT) and may impact on capacity available to deliver SACT services in NHSScotland. As part of the COVID-19 cancer treatment response strategy, interim governance arrangements for cancer medicines has been issued by Scottish Government Health Department. These arrangements are being led by the COVID 19 National Cancer Medicines Advisory Group (NCMAG) which will, wherever possible, oversee a ‘Once for Scotland’ approach to interim changes to practice in the treatment of adult patients.

Decisions on treatment will need to be made on an individual patient basis by clinicians in discussion with the patient and, where appropriate, the multidisciplinary team (MDT). There will also be decisions made which will apply to groups of patients, notwithstanding that individual documented patient discussions will still be required.

The aim of the interim treatment options summarised in the table below is to allow for greater flexibility in the management of cancer during COVID-19 pandemic to ensure clinicians have additional treatment options through this time. These changes have been proposed by specialist teams and supported by NCMAG in line with the interim cancer medicines governance framework.

Decisions regarding the provision of NHS services remain as matters for NHS Boards; and clinicians remain responsible for clinical decisions regarding the care of individual patients. The interim changes are valid during the COVID-19 pandemic period only and will be withdrawn at an appropriate time point. Each NHS board must ensure all internal governance arrangements are completed before medicines are prescribed. The benefits and risks of the use of a medicine should be clearly stated and discussed with the patient to allow informed consent.

Patients commenced on an interim treatment supported by NCMAG during the COVID-19 pandemic should be allowed to continue the treatment until it is considered appropriate by patient and clinician to stop or to switch to a different treatment.

The following interim treatment changes have been and assessed by NCMAG and implemented in line with the SGHD framework but do not constitute SGHD guidance.

List of Proposals supported by the National Cancer Medicines Advisory Group (Last updated: 08 June 2020)

Cancer type

Treatment

Interim use

Breast

Trastuzumab

Treatment of adult patients with human epidermal growth factor receptor 2 (HER2) positive early breast cancer, following surgery, chemotherapy (neo-adjuvant or adjuvant) and radiotherapy (if applicable).

A reduced treatment duration of 6-months, or 9 cycles, for patients categorised as lower risk

Gastrointestinal

Pembrolizumab

In first line setting only, for treatment of patients with metastatic microsatellite instability high (MSI-H) colorectal cancer who would otherwise receive immunosuppressive cytotoxic chemotherapy as part of their treatment regimen

 

Gynaecological

Olaparib

Treatment without preceding chemotherapy in patients with high grade epithelial tubo-ovarian cancer who have a deleterious somatic or germline BRCA mutation who have a recent relapse of platinum sensitive disease

 

Gynaecological

Olaparib in combination with bevacizumab

Treatment of stage 4 BRCA wild-type tubo-ovarian cancer following cessation of neo-adjuvant chemotherapy in the time prior to delayed primary surgery

Gynaecological

Niraparib

Maintenance treatment for patients with advanced high grade epithelial tubo-ovarian cancer, with no BRCA mutation, in response to neo-adjuvant chemotherapy in the time prior to undergoing delayed primary surgery

 

Head and neck

Pembrolizumab

Monotherapy for the first-line treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma (HNSCC) regardless of PDL1 expression status

 

Leukaemia

Ibrutinib

Single agent for the treatment of adult patients with previously untreated chronic lymphocytic leukaemia (CLL) who would normally have been offered entry into the FLAIR trial or received the following chemoimmunotherapy regimens: rituximab-fludarabine-cyclophosphamide (R-FC), rituximab-bendamustine or obinutuzumab- chlorambucil

 

 

Lung

Pembrolizumab

Monotherapy for the first-line treatment of metastatic non-small cell lung cancer (NSCLC) in adults whose tumours express PD-L1 with a 1 to 49% tumour proportion score, with no EGFR or ALK positive tumour mutation

 

Myeloma

Carfilzomib in combination with dexamethasone alone

Treatment of adult patients with multiple myeloma who have received at least one prior therapy. Once-weekly carfilzomib dosing.

Myeloma

Lenalidomide in combination with dexamethasone

First line treatment of patients with multiple myeloma who are not eligible for transplant.

Myeloma

Pomalidomide in combination with dexamethasone

Second or third line treatment of relapsed and refractory multiple myeloma in patient who have progressed on previous treatment with a regimen containing lenalidomide.

Myeloma

Lenalidomide in combination with cyclophosphamide and dexamethasone (RCD)

First line treatment for transplant eligible patients with newly diagnosed myeloma

Supportive treatment

Apixaban

Prophylaxis of venous thromboembolism in multiple myeloma patients treated with immunomodulatory drugs who would otherwise require administration of low weight molecular heparin by a person outside of their household

 

Urological

Abiraterone plus prednisolone

Treatment of newly diagnosed low risk metastatic hormone sensitive prostate cancer in adult men in combination with androgen depravation therapy

Urological

Pembrolizumab in combination with axitinib

First-line treatment of intermediate or poor risk advanced renal cell carcinoma, in patients who would otherwise receive ipilimumab plus nivolumab

 

non-specific

Granulocyte colony stimulating factor (GCSF)

Prevention of neutropenic events in patients receiving cytotoxic systemic anti-cancer therapy (SACT) during COVID-19

First published: 9 Jun 2020 Last updated: 12 Oct 2020 -