Table 4.

Clinical scenarios to illustrate balance of survival benefit from cancer and increased risk of death from COVID-19 with chemotherapy

Tumour Site	Clinical decision tool/evidence	Case history	Treatments and benefit	Risk–benefit analysis
Breast	NHS PREDICT (breast cancer)	71-year-old post-menopausal woman with a symptomatic pT3 (60 mm) N0 M0 ER+ HER2- G3 IDC who has a WLE + SLNB.	Survival at 10 years: Surgery only = 45% + hormone therapy = 54% + chemotherapy = 54% + bisphosphonates = 63%	There is a 4.8% benefit at 10 years with adjuvant FEC (second generation) chemotherapy. This compares with the increased risk of death if she acquires COVID-19 of 2.4%
Lung	LACE Meta-analysis	68-year-old male with resected stage IIIA NSCLC, EGFR wild-type; PDL1 <1%	Survival at 5 years: Surgery only = 43.4% + chemotherapy = 48.8%	There is a 5.4% survival benefit at 5 years with cisplatin-based chemotherapy. This compares with the increased risk of death if he acquires COVID-19 of 1.2%
Brain	Stupp 2009	63-year-old male with WHO grade IV resected, MGMT methylated glioblastoma multiforme	Survival at 5 years: Surgery and radiotherapy = 0% + chemotherapy = 11%	There is an 11% survival benefit at 5 years with concurrent and adjuvant temozolamide This compares with the increased risk of death if he acquires COVID-19 of 0.3%

IDC: Invasive Ductal Carcinoma; WLE: Wide local excision; SLNB: Sentinel Lymph Node Biopsy; NSCLC: Non-small cell lung cancer; EGFR: Epidermal Growth Factor Receptor; PDL-1: Programmed Death Ligand-1; MGMT: Methyl-guanine-methly-transferase.