Table 3.

Additional considerations for priority categories for medical oncology

Agent	Dosing and scheduling considerations
Chemotherapy	Chemotherapy schedules may be modified to reduce clinic visits (using 2- or 3-week dosing, e.g.) or to reduce infection risk (using weekly dosing) for selected agents when appropriate
	For low-risk febrile neutropenia, outpatient regimens may be used
	Selected patients (particularly with ER + disease), can consider radiation before chemotherapy if this facilitates patient safety
Targeted therapy	The addition of oral targeted agents (CDK 4/6, mTOR, or PIK3CA inhibitors) to endocrine therapy may be delayed in first-line treatment, or in situations where endocrine therapy alone is providing or is likely to provide effective tumor control
	Cardiac monitoring (Echo, nuclear) during HER2 antibody therapy can be delayed or discontinued if clinically stable
	Consider reduced dose of oral targeted agents to optimize tolerability and minimize treatment-related toxicities
	Trastuzumab and pertuzumab for metastatic HER2 + BC may reasonably be administered at longer intervals (e.g. 4 weeks)
Endocrine therapy	Oral endocrine agents (e.g. tamoxifen, aromatase inhibitors) are not immunosuppressive and can be safely continued
	Fulvestrant is not immunosuppressive but requires monthly clinical administration
	Aromatase inhibitors are preferred over tamoxifen for neoadjuvant endocrine therapy (and LHRH agonists should be used for premenopausal women)
Supportive care	Extend venous access device (port) flush to 12 weeks or longer
	Consider peripheral venous access for IV chemotherapy if patient has sufficient veins and no existing port if institutional policies permit
	Administer G-CSF growth factor support to minimize neutropenia
	Limit dexamethasone when possible to reduce immunosuppression

ER estrogen receptor, LHRH luteinizing hormone releasing hormone, HER2 human epidermal growth factor receptor 2, IV intravenous, G-CSF granulocyte colony-stimulating factor