Thread by @cpeedell

THREAD: Should we continue to offer concurrent ChemoRT and Durvalumab in selected stage III NSCLC patients during the #COVID19 outbreak?
I think yes, and this thread explains why #radonc #medonc #lcsm

Chemo added sequentially to RT gives ~5% absolute Overall Survival (OS) benefit to RT alone at 5 years. ChemoRT given concurrently adds a further 4.5% absolute OS benefit at 5 years (Auperin meta-analysis). #lcsm #radonc #medonc #covid19

We now know that addition of Durvalumab after concurrent ChemoRT improves absolute 3 year OS from 43.5% to 57% (PACIFIC trial). The curves are not coming together, with both curves flattening, suggesting 5yr absolute OS benefit will be maintained ie at least 10%
#radonc #medonc

In summary concurrent CRT plus Durva likely to add 20%+ absolute survival benefit at 5 years versus giving RT alone.
*BUT*, we now have to factor in the mortality *risk* of giving chemo and IO during the #COVID19 outbreak....

Computer modeling from Imperial College, London has suggested giving chemo during #COVID19 outbreak could have a mortality rate of >5%. (Commonest age range for giving ChemoRT is 60-70). We know less about IO, but risk is also likely to be higher medrxiv.org/content/10.110…

There are clearly a lot of uncertainties here, and multiple visits to hospital will increase chance of being infected. On balance though, I think the 20%+ absolute OS benefit versus RT alone is worth the risk at this stage. These patients are generally fitter & younger too

We use the SOCCAR regimen. Cis/Vin concurrent with with 55Gy in 20 fractions. We are going to drop the 2 neoadjuvant cycles we normally give and go straight into concurrent. It’s a tough regimen, so for fit PS0-1 only & younger patients (<70yrs). ejcancer.com/article/S0959-…

There is also the issue of giving a year (26 cycles) of adjuvant durvalumab. I just think we need to be as cautious as possible and take all the necessary infection control measures to reduce infection risk. #covid19 #lcsm #medonc #radonc

We are clearly in a very rapidly changing situation and we may come to the point that offering any cytotoxic treatment that increases hospital admission risk will have to stop. Let’s hope and pray we never get to that point. Keep safe all #radonc #medonc #covid19 #lcsm