Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role.Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians.A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was "Covid AND Radiotherapy" and only original articles in the English language were considered.A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results.RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period. 

/pdf/covid-19-and-radiotherapy-a-systematic-review-after-2-years-1ofqeu3p.pdf

Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

Background: During the COVID-19 pandemic, health resources were stretched, access was impacted by lockdowns and there were concerns about exposure to the virus during visits to hospitals. The purpose of this study was to examine how breast cancer treatments (presentation, surgery, radiotherapy, chemotherapy and/or endocrine therapy) changed or were adapted during the early phase of the pandemic.
Methods: A systematic review was conducted using PRISMA guidance. Eligible studies presented original data reporting changes to early breast cancer treatment by comparing ‘pandemic’ treatment to a ‘pre-pandemic’ cohort or to ‘ideal’ treatment of individual cases. Data were extracted into evidence tables and narrative synthesis was used to analyse results.  
Results: Fifteen studies with paired design were eligible. These reported outcomes for 6,353 people treated for early breast cancer (January 2020–June 2021). All studies reported some change to treatment due to the pandemic. The nature of reported changes was inconsistent. Changes included: tumours more advanced at presentation compared to pre-pandemic, increase in breast conserving surgery;  increase in simple mastectomy (without breast reconstruction); trend towards increased wait times, delays to start of treatment, shorter post-operative hospital stay and hypofractionation or omission of radiotherapy. Centres used more or less neoadjuvant chemotherapy or endocrine therapy.
Conclusion: In the early stage of the pandemic, fewer early-stage breast cancer cases were treated many centres. Treatment for breast cancer was impacted and various local solutions were developed. These included less complicated breast surgery, increased use of neoadjuvant therapy, and changes to radiotherapy regimens. Surgery was frequently delayed and breast reconstruction was often unavailable. These results have implications for breast cancer services during the pandemic recovery as a ‘catch-up’ increase in cancer diagnoses is expected. Women may wish to access breast reconstruction, unavailable due to COVID-19. The impact of changes to treatment on long-term quality of life should be evaluated.

The Impact of COVID-19 on Breast Cancer Treatment: A Systematic Review

Background and importance Palbociclib is an oral selective inhibitor of the cyclin dependent kinases CDK4 and CDK6 labelled for the treatment of adult patients with hormone receptor (HR) positive, human epidermal growth factor receptor 2 (HER2) negative advanced or metastatic breast cancer. The most frequent adverse events (AEs) reported in pivotal studies were neutropenia, leucopenia, anaemia, stomatitis, nausea, diarrhoea, alopecia, infections and fatigue. Among these, the most common grade 3 or grade 4 AEs were neutropenia, fatigue and infections. In the pivotal studies, 34% of patients required a decrease in their palbociclib dose and 4% of patients required permanent discontinuation. Currently, real life toxicity data on palbociclib are still scarce. Aim and objectives The aim of this study was to assess the real world tolerability of palbociclib and to compare our results with the safety outcomes of the pivotal studies. Material and methods We collected real life toxicity data by analysing computerised health records, internal databases and pharmacovigilance reports, and subsequently we compared the incidence of toxicity, dose modifications and permanent discontinuations due to AEs with data reported in the pivotal studies. Results In an oncological hospital, 199 patients were treated with palbociclib, 149 in association with fulvestrant and 50 with letrozole. Palbociclib dose reduction occurred in 77/199 (38%) patients due to AEs, 14/199 (7%) requiring second level of dose reduction. In total, 67/77 (87%) patients had dose reductions due to haematological toxicity, mainly neutropenia, 15 of whom had other haematological toxicities. Overall, 10/199 (5%) patients had permanent discontinuation for any toxicity, 7 due to non-haematological toxicity, mainly hepatic toxicity, epigastralgia and astenia. Conclusion and relevance The incidence of haematologic and non-haematological reactions, dose reductions and treatment interruption due to toxicity in real world clinical practice were comparable with the results obtained in the pivotal studies. Haematological toxicity, particularly neutropenia, was the first cause of dose reduction, while non-haematological toxicity was found to be the first cause of definitive treatment interruption. References and/or acknowledgements No conflict of interest.

https://ejhp.bmj.com/content/ejhpharm/27/Suppl_1/A172.1.full.pdf

5PSQ-049 Palbociclib in metastatic breast cancer treatment: real life toxicity and frequency of dose reduction or permanent discontinuation

Management of breast cancer patients during the peak of the COVID 19 pandemic

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Management of breast cancer patients during the peak of the COVID 19 pandemic

5PSQ-049 Palbociclib in metastatic breast cancer treatment: real life toxicity and frequency of dose reduction or permanent discontinuation