Table 1.
Cancer type and/or localisation | Stage | Antineoplastic protocol | Therapeutic adjustment options in the limits and rules of the national regulatory agencies, and as per local guidelines and practice | Reference | |
---|---|---|---|---|---|
Lung cancer | NSCLC | Adjuvant | Cisplatin – Paclitaxel | Carboplatin - Paclitaxel + G-CSF | [48], [49] |
Locally advanced | Durvalumab | Reduced frequency Q4W and double the dose | [45], [50] | ||
Metastatic | Nivolumab | Discontinuation of immunotherapy after 2 years of treatment should be considered. Stop (>2year) or reduced frequency Q4W and double the dose | [41], [45], [46], [48], [51] | ||
Metastatic | Pembrolizumab | Discontinuation of immunotherapy after 2 years of treatment should be considered. Stop (>2year) or reduced frequency Q6W and double the dose | [41], [45], [47], [48], [51] | ||
Metastatic | TKI targeting EGFr | Treatment continuation and monitoring using telemedicine | [48], [51] | ||
SCLC | Local | Cisplatin – Etoposide (± atezolizumab or durvalumab) | Carboplatin – Etoposide + G-CSF (± atezolizumab or durvalumab) | [48], [53] | |
Skin cancer | Melanoma | Adjuvant or advanced | Nivolumab Q2W Pembrolizumab Q3W |
Reduced frequency (nivolumab Q4W and pembrolizumab Q6W) and double the dose | [46], [47], [52] |
Genitourinary | Prostate | Metastatic first line | Docetaxel | Androgen deprivation + abiraterone/enzalutamide (expert consensus) | [54], [55], [56] |
Prostate | Metastatic pre-treated with second generation hormonotherapy | Docetaxel | Avoid or reduce the number of docetaxel cycles + G-CSF (expert consensus) | [54], [55] | |
Seminoma | Metastatic with intermediate risk | BEP Protocol | Avoid bleomycin (VIP + G-CSF) (expert consensus) | [54], [55] | |
Bladder | Metastatic first line | Intensive MVAC Protocol | Cisplatin – Gemcitabine + G-CSF (expert consensus) | [54], [55] | |
Kidney | Metastatic with high or intermediate risk | Ipilimumab-Nivolumab | TKI sunitinib or pazopanib (expert consensus) | [54], [55] | |
Digestive | Colic | Adjuvant | FOLFOX | CapOx or capecitabine monotherapy (low risk) or no treatment (frail patients) (expert consensus) | [35], [57] |
Colorectal | Metastatic unresectable | FOLFOX or FOLFIRI ± targeted therapy | Capecitabine or CapOx or CapIri ± targeted therapy (expert consensus) | [35], [57] | |
Pancreas | Local | FOLFIRINOX | FOLFOX or FOLFIRINOX without 5-FU bolus and cap irinotecan at 150 mg/m2; add G-CSF | [35], [57], [58], [59] | |
Gastric | Local | FLOT perioperative | FLOT + G-CSF or CapOx (if no dysphagia) | [35], [57], [60] | |
Oesogastric | Metastatic | FOLFOX ± trastuzumab | CapOx ± trastuzumab (if HER2+++) (expert consensus) | [61] | |
Anal cancer | Metastatic | 5FU-cisplatin or DCF protocol | CapOx or carboplatin - capecitabine (expert consensus) | [35] | |
GIST | Adjuvant post-operative | TKI targeting bcr-abl | TKI continuation and monitoring using telemedicine (expert consensus) | [35] | |
Breast | Breast | Metastatic | CDK4/6 inhibitors | Adapt doses or postpone CDK4/6 inhibitors to avoid neutropenia (expert consensus) | [62], [63] |
Upper Aero-digestive Tract | Head and Neck | Metastatic | TPEx | Adapt schedule from Q3W to Q2W with reduced doses of cisplatin and docetaxel (both 40 mg/m2) and cetuximab 500 mg/m2 (expert consensus) | [64] |
Neuro-oncology | Glioma IDH-wt MGMT-methylated |
High grade | Chemo-radiotherapy with temozolomide | Treatment continuation (expert consensus) | [65], [66] |
Glioma IDH-wt | High grade | Bevacizumab Q2W | Bevacizumab Q6W to Q8W (expert consensus) | [65] | |
Glioma IDH-mutated | Oligo-symptomatic | Procarbazine, lomustine, vincristine | Consider to report for 6 months or more (expert consensus) | [65] | |
Hematology | Follicular lymphoma | Induction | Immuno-chemotherapy anti-CD20-based | Anti-CD20 alone If chemotherapy is necessary, prefer R-CHOP to R-Bendamustine (expert consensus) |
[67], [68] |
Follicular lymphoma Mantle cell lymphoma |
Maintenance | Anti-CD20 | Consider to report or remove maintenance cycles | [67], [68], [69] | |
Chronic Lymphocytic Leukaemia | Induction | Rituximab and venetoclax | Avoid anti-CD20 and venetoclax. Prefer alternative therapies (expert consensus) | [70] | |
Lymphoblastic Acute Leukaemia | Maintenance | POMP | Stop vincristine and corticosteroids and maintain methotrexate and 6-mercaptopurine (expert consensus) | [71] | |
Multiple Myeloma | Induction | VRD following by ASCT | Report ASCT as possible; replace by 6 or 8 cycles of VRD according to the risk stratification (expert consensus) | [72], [73] | |
Induction/consolidation or relapsed/refractory | Dexamethasone 40 mg weekly | Decrease dexamethasone to 20 mg weekly or avoid if possible | [72], [73], [74] | ||
Relapsed and/or refractory | Carfilzomib D1-2 Daratumumab Q2W |
Reduce carfilzomib frequency D1 Daratumumab monthly frequency until cycle 3 (expert consensus) |
[72], [73], [75] |
ASCT: Autologous Stem Cell Transplant; BEP: Bleomycin, Etoposide, CapOx: Capecitabine, Oxaliplatin; CapIri: Capecitabine, Irinotecan; Cisplatin; COVID-19: Coronavirus Disease-19; EGFr: Epidermal Growth Factor receptor; FLOT: Docetaxel, 5-fluorouracile, oxaliplatin; FOLFOX: Oxaliplatin, 5-fluorouracile; FOLFIRI: Irinotecan, 5-fluorouracile; FOLFIRINOX; Oxaliplatin, Irinotecan, 5-fluorouracile; G-CSF: Granulocyte-Colony Stimulating Factors; GIST: Gastro-Intestinal Stromal Tumor; GRAALL: Group for Research on Adul Acute Lymhoblastic Leukemia; IDH: Isocitrate deshydrogenase; MGMT: O-6-methylguanine-DNAmethyltransferase; MVAC: Methotrexate, Vinblastine, Doxorubicin, Cisplatin; NSCLC: Non-Small Cell Lung Cancer; POMP: Methotrexate, Vincristine, Prednisone, Mercaptopurine; Q2W: Every 2 weeks; Q3W: Every 3 weeks; Q6W: Every 6 weeks; Q8W: Every 8 weeks; R-CHOP: Rituximab, Cyclophosphamide, Doxorubicine, Vincristine, Prednisone; TPEx: Docetaxel, Cisplatin, Cetuximab; VRD: Velcade, Revlimid, Dexamethasone; wt: Wild Type; SCLC: Small Cell Lung Cancer; TKI: Tyrosine Kinase Inhibitor; VIP: Vinblastine, Ifosfamide, Cisplatin;