The tiered approach of ESMO in delivering a guidance for cancer patients during the COVID-19 pandemic is designed across three levels of priorities, namely: tier 1 (high priority intervention), 2 (medium priority) and 3 (low priority) – defined according to the criteria of the Cancer Care Ontario, Huntsman Cancer Institute and ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS), incorporating the information on the value-based prioritisation and clinical cogency of the interventions
- High priority: Patient's condition is immediately life threatening, clinically unstable, and/or the magnitude of benefit qualifies the intervention as high priority (e.g. significant overall survival [OS] gain and/or substantial improvement in quality of life [QoL]);
- Medium priority: Patient's situation is non-critical but delay beyond 6 weeks could potentially impact overall outcome and/or the magnitude of benefit qualifies for intermediate priority;
- Low priority: Patient's condition is stable enough that services can be delayed for the duration of the COVID-19 pandemic and/or the intervention is non-priority based on the magnitude of benefit (e.g. no survival gain with no change nor reduced QoL).
Renal cell cancer management in challenging environments and health care systems
Outpatient visit priorities
Priorities for imaging
Priorities for surgical oncology
For guidance on management of localised disease see guidelines of the European Urology Association (EAU) on “Considerations in the triage of urologic Surgeries during the Covid-19 pandemic”
- General comment: All cytoreductive nephrectomies should be postponed whenever feasible. Avoid surgery for metastatic disease
Priorities for radiation oncology/interventional radiology
Priorities for medical oncology – advanced disease (systemic treatment)
- Immunotherapy regimes with a longer interval (4-weekly nivolumab or 6-weekly pembrolizumab) should be used where possible
- Consider the elevated risk of potential pulmonary toxicities of immune checkpoint inhibition (especially of CTLA-4/PD-L1 combination)
List of abbreviations: AE, adverse event; COVID-19, severe acute respiratory syndrome coronavirus 2-related disease; CT, computed tomography; CTLA-4, cytotoxic T-lymphocyte-associated protein 4; GI, gastrointestinal; ICI, immune checkpoint inhibitor; IMDC, International Metastatic Renal Database Consortium; irAE, immune-related adverse event; MRI, magnetic resonance imaging; PD-L1, programmed death-ligand 1; TKI, tyrosine kinase inhibitor; VEGF, vascular endothelial growth factor.