Conforti, Claudio

Di Meo, Nicola

Giuffrida, Roberta

Zalaudek, Iris

English

Archivio istituzionale della ricerca - Università di Trieste

Management of advanced melanoma in the COVID-19 eraDear Editor,The coronavirus disease 2019 (COVID-19) pandemic, caused by anRNA virus, called SARS-CoV-2 (severe acute respiratory syndromecoronavirus 2),1 required many unnecessary outpatient proceduresand dermatological treatments to be postponed. Otherwise, urgentvisits and surgery that cannot be postponed are carried out regularly.For patients undergoing treatment with immunosuppressive orimmunomodulating drugs for chronic dermatological diseases, such aspsoriasis, several guidelines suggest to assess on a case-by-case basisthe initiation of a new therapy with a biological drug as well as thepossible suspension in case of positivity.2 Apart from psoriasis, whichcan sometimes also be treated in an alternative way, we must focusour attention on the most fragile patients in dermatology, that is,oncologic patients suffering from advanced melanoma. In fact, weshould remember that cancer-related treatments may cause immuno-suppression, and the first available data suggest that patients withcancer have a risk of excess mortality due to SARS-CoV-2.3Many of melanoma patients are treated with targeted therapy orimmunotherapy (eg, dabrafenib + trametinib, vemurafenib +cobimetinib, encorafenib + binimetinib, pembrolizumab, nivolumab,ipilimumab) in an adjuvant or palliative setting, and currently data arelacking how to manage oncologic COVID-19-positive patients. Fewguidelines suggest that patients should not discontinue ongoing ther-apy but do not provide guidance on how to behave in case of anasymptomatic or symptomatic COVID-19 patient on treatment withtarget therapy or immunotherapy.4The Italian Association of Medical Oncology (AIOM), consideringthat the continuity and timeliness of antineoplastic treatments mustalways be guaranteed, has also suggested to consider case by case thepossibility of postponement of a treatment, based on the biologicalcharacteristics of the tumor and the clinical features of the patient.5The European Society for Medical Oncology (ESMO) suggests thatall patients undergoing surgery, radiotherapy, chemotherapy, or immu-notherapy should be swabbed for SARS-CoV-2 if possible and ideallybefore each treatment/cycle. Decisions for initiation or continuation oftreatment should be discussed for both noninfected and SARS-CoV2-positive patients, both asymptomatic and paucisymptomatic.6At the moment we have no clear data and we need as dermato-oncologist to have a common conduct for these patients. For this rea-son, based on current considerations of the major oncologic societiesand our clinical practice, we suggest (a) to encourage patients not todiscontinue ongoing target therapy or immunotherapy independently,(b) in case of flu symptoms patients should not discontinue therapybut contact immediately their oncologist or dermato-oncologist, (c) toperform a swab before starting or continuing medical chemotherapy/immunotherapy or in the case of major surgeries requiring frequentattendance to the hospital, and (d) in case of COVID-19-positive(symptomatic or paucisymptomatic) patients, we suggest to evaluatepatients on a case-by-case basis and if necessary consider suspendinga cycle of treatment for both treatments.CONFLICT OF INTERESTThe authors declare no conflicts of interest.Claudio Conforti1Roberta Giuffrida2Nicola Di Meo1Iris Zalaudek11Department of Dermatology and Venereology, University of Trieste,Ospedale Maggiore, Trieste, Italy2Department of Clinical and Experimental Medicine, Section ofDermatology, University of Messina, Messina, ItalyCorrespondenceRoberta Giuffrida, Department of Clinical and Experimental Medicine,Dermatology, University of Messina, Italy.Email: roberta_giuffrida@hotmail.itORCIDClaudio Conforti https://orcid.org/0000-0001-5126-8873Roberta Giuffrida https://orcid.org/0000-0002-5492-3033REFERENCES1. Conforti C, Cannavò SP, Jafferany M, et al. Coronavirus disease 2019(COVID-19): facts and controversies. Dermatol Ther. 2020;33(4):e13366. https://doi.org/10.1111/dth.13366.2. Conforti C, Giuffrida R, Dianzani C, Di Meo N, Zalaudek I. COVID-19and psoriasis: is it time to limit treatment with immunosuppressants? Acall for action. Dermatol Ther. 2020;33(4):e13298. https://doi.org/10.1111/dth.13298.3. Schrag D, Hershman DL, Basch E. Oncology practice during theCOVID-19 pandemic. JAMA [Epub ahead of print]. 2020. https://doi.org/10.1001/jama.2020.6236.4. SIDeMaST, Infezione da Coronavirus: Vademecum per i pazienti affettida psoriasi cutanea e/o artropatia psoriasica, 2020 https://www.sidemast.org/blog/coronavirus.5. AIOM, Rischio infettivo da Coronavirus Covid-19: indicazioni perl'oncologia, 2020https://www.aiom.it/wp-content/uploads/2020/03/20200313_COVID-19_indicazioni_AIOM-CIPOMO-COMU.pdf.6. ESMO, Cancer patient management during the covid-19 pandemic,https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic?hit=ehp.

Management of advanced melanoma in the COVID-19 era

https://arts.units.it/retrieve/handle/11368/2966345/447474/11368_2966345_print.pdf

Management of advanced melanoma in the COVID-19 era

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Archivio istituzionale della ricerca - Università di Trieste