Professor Shen Bo: "Lung" often fights "epidemic" - diagnosis and treatment and protection of lung cancer patients under the new crown epidemic

Since December 2022, many places have experienced the pandemic phase of new crown infection, and the number of infection cases has increased in
the short term.
Due to immunocompromised and other reasons, patients with malignant tumors are one of
the susceptible groups for the new coronavirus.
As lung cancer is the malignant tumor with the highest incidence, how to enable lung cancer patients to safely and smoothly survive this "lung" common battle and "epidemic" has become a hot issue
of widespread clinical concern.
In this regard, Yimaitong specially invited Professor Shen Bo of Jiangsu Cancer Hospital to share the diagnosis and treatment concepts and protective measures
of lung cancer patients during the epidemic.

Expert profiles

Prof.
Bo Shen

• Deputy Director of Internal Medicine of Jiangsu Cancer Hospital/Nanjing Medical University Cancer Hospital

• Chief physician, researcher, doctor/postdoctoral supervisor

• There are young and middle-aged experts with outstanding contributions in Jiangsu Province

• Member of the National Health Commission Capacity Building and Continuing Education Oncology Committee

• Member of the Lung Cancer Quality Control Expert Committee of the National Cancer Quality Control Center

• Member of the Standing Committee and Secretary-General of the Cancer Clinical Chemotherapy Committee of the Chinese Anti-Cancer Association

• Member of the Lung Cancer Professional Committee of the Chinese Anti-Cancer Association

• Member of the Multidisciplinary Diagnosis and Treatment of Oncology (MDT) Committee of the Chinese Medical Doctor Association

• Vice Chairman of the Tumor Metastasis Special Committee of the Chinese Medical Education Association

• Member of the Lung Cancer Special Committee of the Chinese Medical Education Association

• Member of the CSCO Expert Committee on Non-Small Cell Lung Cancer

• Member of the CSCO Expert Committee on Vascular Targeted Therapy

• Chairman of the Translational Medicine Branch of Jiangsu Society of Immunology

• Chairman of the Lung Cancer Special Committee of Jiangsu Integrative Medicine Research Association

• Vice Chairman of the Multidisciplinary Diagnosis and Treatment Committee of Jiangsu Medical Doctor Association

• Vice Chairman of the Special Committee for Tumor Recurrence and Metastasis of Jiangsu Anti-Cancer Association

• Vice Chairman of Jiangsu Anti-Cancer Association Tumor Precision Treatment/Pancreas Special Committee

• Vice Chairman of the Biotherapeutics Special Committee of Jiangsu Research Hospital Association

• Vice Chairman of the Lung Cancer Quality Control Committee of Jiangsu Provincial Cancer Professional Quality Control Center

• Member of the Standing Committee and Academic Secretary of the Cancer Chemotherapy and Biological Therapy Branch of Jiangsu Medical Association

Repeated hospital visits, advanced age, many comorbidities and other factors lead to a greater risk of lung cancer infection with the new coronavirus

Prof.
Bo Shen

Jiangsu Cancer Hospital

Lung cancer patients are susceptible to the new crown virus, Professor Shen believes that lung cancer patients are vulnerable to the new crown threat may mainly be the following reasons: First, the survival time of previous lung cancer patients is relatively short, in recent years, with the advancement of anti-angiogenic therapy, targeted therapy and immunotherapy, the survival time of advanced lung cancer patients has been significantly extended
.
Median overall survival (OS) has been reported in patients with advanced non-small cell lung cancer (NSCLC) to exceed 3 ^years1
。 During these 3 years, lung cancer patients need to go to the hospital repeatedly, and the hospital is a crowded place, so lung cancer patients are prone to infection with the new coronavirus due to repeated visits to medical places due to treatment needs; Second, the high incidence of lung cancer is 65-70 years old, and advanced age is a high risk factor for new crown virus infection, so age is also an important reason why lung cancer patients are prone to new crown infection; Third, tumor patients often have a variety of underlying diseases, such as heart disease, hypertension, diabetes, etc.
, according to the new crown diagnosis and treatment guidelines, the above underlying diseases are high-risk factors for new crown infection; Fourth, lung cancer is a respiratory tumor, and many lung cancer patients have a long-term smoking history, or a history of chronic inflammation, and these patients have poor airway function and are easily invaded by ^viruses2
.

Compared with the normal population, lung cancer patients have more serious clinical symptoms after infection with the new crown

Prof.
Bo Shen

Jiangsu Cancer Hospital

In the same exposed situation, lung cancer patients are more likely to be infected with the new crown virus than the normal population, and the clinical symptoms of lung cancer patients after infection are more serious, Professor Shen pointed out, this is mainly due to two reasons: on the one hand, lung cancer patients themselves have chest pain, cough and other symptoms, infection with the new crown will appear on the basis of the original lung cancer symptoms on the basis of bone soreness, muscle aches and other symptoms of viral infection, so the patient's symptoms are aggravated; On the other hand, lung cancer patients are older, there are many underlying diseases, and after infection with the new crown, the proportion of severe disease and the mortality rate caused by severe disease are significantly higher than those of the normal population
.
In addition, during the treatment of lung cancer, radiotherapy may cause radiation pneumonia, immunotherapy may cause mild or potential immune inflammation, when the new coronavirus invades the lungs of lung cancer patients from the upper respiratory tract, the viral pneumonia caused by it will be worse
for lung cancer patients with underlying lung diseases or lung changes caused by anti-tumor therapy.
In general, lung cancer patients are quite different
from the normal population after being infected with the new crown, both in terms of clinical symptoms and prognosis.

During the infection of the new crown, clinicians should carry out individualized diagnosis and treatment according to the actual condition of lung cancer patients

Prof.
Bo Shen

Jiangsu Cancer Hospital

In order to further improve the standardized management level of patients with solid tumors during the new crown epidemic, the Tumor Support Treatment Professional Committee of the Chinese Anti-Cancer Association and the Clinical Chemotherapy Committee of the Chinese Anti-Cancer Association jointly formulated the "Chinese Expert Consensus on Issues Related to the Protection and Diagnosis and Treatment Management of Solid Tumor Patients during the Novel Coronavirus Pneumonia Epidemic (2022 Edition)^"3 The core content of this consensus is how tumor patients should restart anti-tumor therapy
during infection with the new crown.
Professor Shen pointed out that during the infection of the new crown, the overall diagnosis and treatment concept of tumor patients mainly includes three important aspects: first, safety, to ensure the safety of treatment and patients; The second is stability, and after the patient's new coronavirus infection is basically controlled, anti-tumor treatment will be considered; Third, it is controllable, and the symptoms caused by the new coronavirus and tumor treatment measures must be controllable
.

In addition, Professor Shen emphasized that tumor patients are a special group with low immune function and poor physical status, so anti-tumor treatment needs to be carried out cautiously during infection, which does not mean that patients cannot be treated with anti-tumor during new crown infection, but clinicians should weigh and evaluate whether patients need anti-tumor treatment
after individualized consideration of a variety of factors, such as the risk of new crown infection and tumor diseases, the physical condition of patients, etc.
According to the Chinese Expert Consensus on Issues Related to the Protection and Diagnosis and Treatment Management of Patients with Solid Tumors during the Novel Coronavirus Pneumonia Epidemic (2022 Edition)³, if the tumor disease is not very serious after infection with the new crown, then anti-tumor treatment can be appropriately delayed under the premise of the condition; If the symptoms caused by the tumor are severe and life-threatening, then the patient should be treated accordingly, such as targeted therapy
for those with positive driver gene mutations.
In fact, most experts believe that most targeted therapies and anti-angiogenic therapies have relatively little cross-impact with the new crown, and chemotherapy and radiotherapy should be carried out with caution during infection with the new crown, especially chemotherapy, which is recommended to be postponed
.
For radiation therapy, if it is radiation therapy to the lungs, assess the urgency of radiation therapy; If radiotherapy does not involve the lungs, its cross-impact with the new crown is relatively small and can be treated
.

Lung cancer patients who have recovered from the new crown can prevent reinfection through a variety of measures

Prof.
Bo Shen

Jiangsu Cancer Hospital

Based on the current anti-epidemic situation and development trend, the new crown virus can not be completely broken in the short term, and the fight against the epidemic may be a protracted tug-of-war, so lung cancer patients who have been infected with the new crown should continue to be vigilant to reduce the probability
of reinfection 。 Professor Shen said that lung cancer patients should do the following six points to effectively prevent reinfection: first, through the use of immunomodulators and immune enhancers to regulate and improve the immune function of tumor patients, so that patients can avoid reinfection as much as possible, or do not return to severe disease after infection, so that patients can restart anti-tumor treatment as soon as possible; Second, the nutritional status of patients with advanced lung cancer is often relatively poor, and clinicians should conduct nutritional assessment of patients and provide patients with relevant treatments to strengthen nutrition; Third, minimize the contact of lung cancer patients in society or in public places to reduce the risk of reinfection of patients; Fourth, patients with slow tumor progression and relatively mild disease can choose to use the Internet for online consultation during the new crown epidemic and use relatively simple treatment methods to control their condition; Fifth, tumor patients should be vaccinated in sufficient quantities and courses in accordance with national standards; Sixth, actively strive to intervene in the underlying diseases of tumor patients to prevent patients from becoming asymptomatic or mildly ill to severely ill after being reinfected with the new crown
.

References

1.
Ramalingam S S, Vansteenkiste J, Planchard D, et al.
Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC[J].
New England Journal of Medicine, 2020, 382(1): 41-50.

2.
XU Yan,LIU Hongsheng,HU Ke,WANG Mengzhao.
Clinical management of lung cancer patients during the epidemic of novel coronavirus pneumonia[J].
Chinese Journal of Lung Cancer,2020,23(03):136-141.
)

3.
Tumor Support Treatment Professional Committee of Chinese Anti-Cancer Association, Cancer Clinical Chemotherapy Professional Committee of Chinese Anti-Cancer Association.
Chinese expert consensus on issues related to the protection and diagnosis and treatment management of patients with solid tumors during the novel coronavirus pneumonia epidemic (2022 edition)[J].
Chinese Journal of Oncology,2022,44(10):1083-1090.
)