Table 2.
Priority categories for medical oncology
| Priority | Patient description | COVID-19 treatment considerations |
|---|---|---|
| Priority A | ||
| A | Patients with oncologic emergencies (e.g. febrile neutropenia, hypercalcemia, intolerable pain, symptomatic pleural effusions or brain metastases, etc.) | Initiate necessary management |
| Priority B | ||
| B1 | Patients with inflammatory BC | Neoadjuvant chemotherapy |
| B1 | Patients with TNBC or HER2 + BC | Neo/adjuvant chemotherapy (Neoadjuvant for ≥ T2 or N1) |
| B1 | Patients with mBC for whom therapy is likely to improve outcomes | Initiate chemotherapy, endocrine, or targeted therapy |
| B1 | Patients who already started neo/adjuvant chemotherapy | Continue therapy until complete (if neoadjuvant and responding, can extend treatment if necessary to defer surgery further) |
| B1 | Patients progressing on neoadjuvant therapy | Refer to surgery or change systemic therapy |
| B1 | Patients on oral adjuvant endocrine therapy | Continue therapy |
| B1 | Premenopausal patients with ER + BC receiving LHRH agonists (adjuvant or metastatic) |
- If on aromatase inhibitor, continue LHRH agonist and consider long acting 3 month dosing or home administration - If on tamoxifen, consider deferring LHRH agonist |
| B1 | Patients with clinical anatomic Stage 1 or 2 ER + /HER2- BCs | Neoadjuvant endocrine therapy for 6 to 12 months to defer surgery (may consider gene expression assay on core biopsy) |
| B2 | Patients receiving treatment for Stage 1 HER2 + breast | Ado-trastuzumab emtansine may be substituted for paclitaxel/ trastuzumab |
| B3 | Patients with ER + DCIS | Consider neoadjuvant endocrine therapy to defer surgery |
| B3 | Patients with mBC for whom therapy is unlikely to improve outcomes | Consider deferring chemotherapy, endocrine, or targeted therapy |
| B3 | Patients with HER2 + mBC beyond 2 years of maintenance antibody therapy (trastuzumab, pertuzumab) with minimal disease burden | Consider stopping antibody therapy with monitoring for progression every 3–6 months |
| B3 | Patients with HER2 + BC receiving adjuvant antibody treatment | Consider curtailing antibody treatment after 7 months instead of 12 months |
| Priority C | ||
| C | Patients receiving zoledronic acid, denosumab | Discontinue bone antiresorptive therapy unless for hypercalcemia |
| C | Patients with stable mBC | Interval for routine follow-up restaging studies can be delayed |
| C | Patients with lower risk imaging findings needing follow-up (e.g., small pulmonary nodules) | Interval follow-up can be delayed |
| C | Patients who are candidates for prevention measures (e.g. family history, LCIS or ADH, BRCA1/2 +) | Consider endocrine therapy (as appropriate), delay surgery and screening imaging |
| C | Patients in long-term follow-up for early BC | Defer routine in-person visit |
| C | Patients on aromatase inhibitors | Defer bone density testing (baseline and follow-up) |
BC breast cancer, TNBC triple negative breast cancer, mBC metastatic BC, LHRH luteinizing hormone releasing hormone, ER estrogen receptor, HER2 human epidermal growth factor receptor 2, DCIS ductal carcinoma in situ, LCIS lobular carcinoma in situ, ADH atypical ductal hyperplasia