How I Treat Epithelial Ovarian Cancer during COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) pandemic is accelerating in an unprecedented manner, with 3,175,207 confirmed cases and 224,172 deaths worldwide.[1] Studies from China and Italy reported that individuals with cancer have a two-fold higher rate of COVID-19 infection and a ten-fold higher risk of mortality as compared to individuals patients without cancer.[2], [3], [4] Cancer caregivers are battling in the wake of a scarcity of workforce, personal protective equipment, medications, and risk of COVID-19 infection. This catastrophic situation warrants a relook of management of epithelial ovarian cancer adapted to the local context. Various guidelines on ovarian cancer management and publications of landmark trials were reviewed in this regard, and the latest literature on COVID-19 was studied.[5], [6] These are the suggestions from science and cost-care consortium for managing ovarian cancer patients during the COVID-19 pandemic [Table 1].

Table 1 Summary of consensus opinions for managing ovarian cancer patients during the coronavirus disease 19 pandemic

Clinical scenario	Surgery	Chemotherapy	Maintenance	Follow-up
PDS: Primary debulking surgery, NACT: Neoadjuvant chemotherapy
Newly diagnosed	PDS	Three weekly chemotherapy	None	Three monthly unless
Stage I/II	Delay 4-12 weeks	Delay up to 42 days post-PDS		clinically symptomatic
Newly diagnosed	Interval debulking	Three weekly NACT	Bevacizumab+olaparib/	Monthly for olaparib
Stage III/IV	after neoadjuvant	Delay adjuvant	bevacizumab/observation	Three monthly unless
Neoadjuvant	NACT preferred	chemotherapy±bevacizumab up	for BRCA wild	clinically symptomatic
candidate	Delay 1-4 weeks	to 42 days post IDS	Olaparib for BRCA mutant
Newly diagnosed	PDS	Three weekly chemotherapy	Bevacizumab+olaparib/	Monthly for olaparib
Stage III/IV	Delay 4-12 weeks	Delay adjuvant	bevacizumab/observation	Three monthly unless
Primary debulking		chemotherapy±bevacizumab up	for BRCA wild	clinically symptomatic
surgery candidate		to 42 days post-PDS	Olaparib for BRCA mutant
Platinum sensitive	Avoid/defer	Three weekly chemotherapy ±	Olaparib for responsive	Monthly for olaparib
relapse	secondary	Bevacizumab	disease	Three monthly for
	cytoreductive surgery	Assess after 2 cycle	Observation	observation unless
				clinically symptomatic
Platinum-resistant	Avoid/defer	Cyclophsphamide+bevacizumab/	Observation	Three monthly for
relapse	secondary	epoposide+cyclophsphamide/		observation unless
	cytoreductive surgery	melphalan/olaparib for		clinically symptomatic
		BRCAmutant

Publication History

Received: 29 March 2020

Accepted: 09 April 2020

Article published online:
23 May 2021

• References

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