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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(02): 138-140
DOI: 10.4103/ijmpo.ijmpo_112_20
How I Treat

How I Treat Epithelial Ovarian Cancer during COVID-19 Pandemic

Chandan Krushna Das
Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
,
Shubh Mahindru
Department of Surgical Oncology, Ivy Hospital, Ajitgarh, Punjab, India
,
Amol Patel
Malignant Diseases Treatment Centre, Army Hospital Research and Referral, New Delhi, India
,
Atul Batra
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Bivas Biswas
Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
,
Prashant Mehta
Department of Medical Oncology/Hematology/Bone Marrow Transplantation, Asian Institute of Medical Sciences, Faridabad, Haryana, India
,
Raja Pramanik
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
,
Sainath Bhethanabhotla
Department of Medical Oncology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
,
Vineet Govinda Gupta
Department of Medical Oncology and Hemato-Oncology, Artemis Hospital, Gurugram, Haryana, India
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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

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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