Italian survey on managing immune checkpoint inhibitors in oncology during COVID-19 outbreak

Background: During COVID-19 outbreak, oncological care has been reorganized. Cancer patients have been reported to experience a more severe COVID-19 syndrome; moreover, there are concerns of an interference between immune checkpoint inhibitors (ICIs) and SARS-CoV-2 pathogenesis. Materials and Methods: Between May 6 and 16, 2020, a 22-item survey was sent to Italian physicians involved in administering ICIs. It aimed to explore the perception about SARS-CoV-2 related risks in cancer patients receiving ICIs, and the attitudes towards their management. Results: The 104 respondents had a median age of 35.5 years, 58.7% were females and 71.2% worked in Northern Italy. 47.1% of respondents argued a synergism between ICIs and SARS-CoV-2 pathogenesis leading to worse outcomes, but 97.1% would not deny an ICI only for the risk of infection. During COVID-19 outbreak, to reduce hospital visits, 55.8% and 30.8% opted for the highest labeled dose of each ICI (55.8%) and/or, among different ICIs for the same indication, for the one with the longer interval between cycles, respectively. 53.8% of respondents suggested testing for SARS-CoV-2 every cancer patient candidate to ICIs. 71.2% declared to manage patients with onset of dyspnea and cough as SARS-CoV-2 infected until otherwise proven; however, 96.2% did not reduce the use of steroids to manage immune-related toxicities. The administration of ICIs in specific situations for different cancer types has not been drastically conditioned. Conclusions: These results highlight the confusion around the perception of a potential interference between ICIs and COVID-19, supporting the need of focused studies on this topic.