Multidisciplinary approach to COVID-19 and cancer: Consensus from scientific societies in Argentina

Introduction: The world is living through an outbreak of an acute respiratory syndrome caused by a new betacoronavirus known as coronavirus 2 (SARS CoV-2), which has been declared an international public health emergency by the World Health Organisation. Cancer patients are a very special population in this setting since they are more susceptible to viral infections than the general population. Several recommendations have been made on this issue, most of them based on expert opinion and institutional experience. It is essential to gather the evidence available for decision making. Objective: To review the evidence available in order to create a multi-institutional position from the perspective of scientific societies in Argentina involved in the management of cancer patients. Methodology: The review included two phases: 1) search and systematic revision of the medical literature; 2) consensus and revision of the document drafted by national scientific societies involved in the management and care of cancer patients using the modified Delphi method. The final results were presented at a videoconference with all the participants. Also, additional comment and recommendations were discussed. The final document was revised and approved for publication by the members of the panel. Results: The consensus panel included 18 representatives from scientific societies from Argentina who assessed the evidence and then made recommendations for the management of cancer patients in our country. International guidelines (CDC; ASCO, NCCN and ESMO) were considered as a background for analysis, as well as institutional guidelines and an open ad hoc survey administered to 114 healthcare professionals from the scientific societies involved in this study. The recommendations are grouped as follows: 1) general care interventions-training of the personnel, cleaning and disinfection of the hospital premises and patient scheduling; 2) treatment decisions-patient care, surgeries, immunosuppressive therapy, radiotherapy and screening; 3) ethical considerations-optimisation of resources, end-of-life care for critically-ill patients; 4) management of hospitalised patients; and 5) wellbeing of the healthcare team. The general recommendation arising from the study is that the management of cancer patients must adapt to the exceptional pandemic status quo without disregarding treatment or cure options. Moreover, healthcare professional accompaniment of all patients should not be neglected. All healthcare professionals must make a significant joint effort to create multidisciplinary teams to discuss the most appropriate measures for each particular situation. Conclusions: The scientific evidence available on this topic worldwide is in progress. This together with the epidemiologically shifting scenario poses unprecedented challenges in the management of cancer amidst this global pandemic. Furthermore, the key role of the healthcare structural organisation appears evident, such as the drafting of clear guidelines for all the stakeholders, adaptability to constant change and an interdisciplinary shared vision through consensus to provide adequate care to our cancer patients in the light of uncertainty and fast-paced change.Fil: Ismael, Julia. Asociación Argentina de Oncología Clinica; ArgentinaFil: Losco, Federico. Asociación Argentina de Oncología Clinica; ArgentinaFil: Quildrian, Sergio. No especifíca;Fil: Sanchez, Pablo. No especifíca;Fil: Pincemin, Isabel. Asociación Argentina de Medicina y Cuidados Paliativos; ArgentinaFil: Lastiri, Jose. Asociación Argentina de Oncología Clinica; ArgentinaFil: Bella, Santiago Rafael. Asociación Argentina de Oncología Clinica; ArgentinaFil: Chinellato, Alejandro. Instituto de Oncología de Rosario; ArgentinaFil: Dellamea, Guillermo. Asociación de Oncología del Chaco; ArgentinaFil: Ahualli, Alejandro. Asociación de Oncólogos de Cordoba; ArgentinaFil: Rompato, Silvana. Asociación Formoseña de Oncología Clinica; ArgentinaFil: Velez, Julio. Asociación Oncología Clinica de Corrientes; ArgentinaFil: Escobar, Rafael. Endoscopistas Digestivos de Buenos Aires; ArgentinaFil: Zwenger, Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Rosales, Cristina. No especifíca;Fil: Bagnes, Claudia. No especifíca;Fil: Puyol, Jorge. No especifíca;Fil: Niewiadomski, Dario. Sociedad Argentina de Cancerología (sac); ArgentinaFil: Smecuol, Edgardo. Sociedad Argentina de Gastroenterologia; ArgentinaFil: Nachman, Fabio. Sociedad Argentina de Gastroenterologia; ArgentinaFil: Gonzalez, Eduardo. Sociedad Argentina de Mastología; ArgentinaFil: Ferraris, Gustavo Nestor. Sociedad Argentina de Terapia Radiante; ArgentinaFil: Suppicich, Juan Ramos. Sociedad Argentina de Urología; ArgentinaFil: Price, Paola. Sociedad de Cancerología de la Plata; ArgentinaFil: Medina, Luis. Sociedad de Oncología Clinica de Tucuman; ArgentinaFil: O'Connor, Juan. Asociación Argentina de Oncología Clinica; Argentin

Chemotherapy and autophagy-mediated cell death in pancreatic cancer cells

Autophagy is an evolutionarily preserved degradation process of cytoplasmic cellular constituents and plays important physiological roles in human health and disease. It has been proposed that autophagy plays an important role both in tumor progression and in promotion of cancer cell death, although the molecular mechanisms responsible for this dual action of autophagy in cancer have not been elucidated. Pancreatic ductal adenocarcinoma is one of the most aggressive human malignancies with 2–3% five-year survival rate. Its poor prognosis has been attributed to the lack of specific symptoms and early detection tools, and its relatively refractory to traditional cytotoxic agents and radiotherapy. Experimental evidence pointed at autophagy as a pancreatic cancer cell mechanism to survive under adverse environmental conditions, or as a defective programmed cell death mechanism that favors pancreatic cancer cell resistance to treatment. Here, we consider several phenotypical alterations that have been related to increase or decrease the autophagic process in pancreatic tumor cells. We specially review autophagy as a cell death mechanism in response to chemotherapeutic drugs.Fil: Ropolo, Alejandro Javier. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Ciencias Biológicas. Cátedra de Fisiopatología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Bagnes, Claudia I.. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Molejon, Maria Ines. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Ciencias Biológicas. Cátedra de Fisiopatología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Lo Ré, Andrea Emilia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Ciencias Biológicas. Cátedra de Fisiopatología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Boggio, Veronica. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Ciencias Biológicas. Cátedra de Fisiopatología; ArgentinaFil: Gonzalez, Claudio D.. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Vaccaro, Maria Ines. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Ciencias Biológicas. Cátedra de Fisiopatología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin