key: cord-320599-hxn4bgec authors: Liontos, Michalis; Kaparelou, Maria; Karofylakis, Emmanouil; Kavatha, Dimitra; Mentis, Andreas; Zagouri, Flora; Terpos, Evangelos; Dimopoulos, Meletios-Athanasios title: Chemotherapy resumption in ovarian cancer patient diagnosed with COVID-19 date: 2020-07-30 journal: Gynecol Oncol Rep DOI: 10.1016/j.gore.2020.100615 sha: doc_id: 320599 cord_uid: hxn4bgec • Chemotherapy resumption after convalescence from COVID-19 is safe and feasible. • No guidelines exist for resumption of chemotherapy in patients with COVID-19. • Cancer patients on chemotherapy may develop SARS-CoV-2 antibodies less frequently. COVID-19 pandemic has imposed a great challenge in the management of patients with 30 chronic illnesses and more specifically cancer. Treatment plan of patients with cancer 31 has been modified due to the necessary reallocation of healthcare resources in order to 32 cope with the pandemic [1] and the risk of increased morbidity and mortality among 33 cancer patients infected by . Taken into account these issues, most 34 national and international oncological societies have issued guidelines that assist 35 management of cancer patients throughout this crisis [3] . However, the disease evolves rapidly, and there is continuous need for reliable clinical 37 information. This would allow us to address the following issues in cancer patients: a. CoV-2. 42 We present the case of an ovarian cancer patient who successfully resumed her 43 chemotherapy immediately after the diagnosis and hospitalization for COVID-19 44 pneumonia. Case study 46 A60-year old woman with a history of recurrent ovarian cancer presented in the 47 emergency department on March 28 th due to fever up to 38.5 ο C and pain in the right 48 chest. Symptoms had developed hours prior her admission. The patient was initially diagnosed 20 months ago with stage IIIc high grade serous 50 ovarian cancer and was treated with primary debulking surgery and frontline treatment 51 with Paclitaxel, Carboplatin and Bevacizumab. The patient experienced disease 52 recurrence. The most recent recurrence was three months ago. The patient presented 53 with bowel obstruction and pleural effusion requiring hospitalization and chest tube 54 insertion with pleurodesis. She was started on weekly paclitaxel due to platinum 55 refractory disease with symptomatic relief. Last dose of chemotherapy was two days 56 prior to hospital admission. Her medical history also included paroxysmal atrial 57 fibrillation under treatment with carvedilol and enoxaparin. She was a non-smoker and 58 infrequently drank alcohol. On examination the patient was alert and fully oriented. The temperature was 38.2 ο C, 60 the blood pressure was 95/50mmHg, the pulse 120 beats per minute and oxygen 61 saturation 92%, while she was breathing on ambient air. At pulmonary auscultation 62 there were diminished breath sounds in the right lower lung lobe. The 63 electrocardiogram indicated atrial fibrillation and the chest X-Ray showed blunting of 64 the right costophrenic angle and a small encapsulated pleural effusion ( Figure 1 ). Laboratory values were unremarkable apart from demarcated leukocytosis with 66 neutrophilia (WBC 27,900/mm 3 neutrophils 96.5%), increased LDH 598U/L as well as 67 C-Reactive protein (CRP) 241mg/dl and procalcitonin 3.3ng/ml. Following national 68 guidance during COVID-19 pandemic, the patient was tested for SARS-Cov-2 and the 69 PCR was positive. The patient was then transferred to a COVID reference clinic for further treatment. She 71 was treated with a combined regimen of piperacillin-tazobactam, hydroxychloroquine 72 and azithromycin. A CT scan was performed without typical evidence of pneumonia. Blood and urine cultures were negative and fever resolved at day 3 of hospitalization. The patient experienced diarrhea on days 6 and 7. Stool exams were negative for fecal 75 leukocytes and C. Difficile by enzyme immunoassay for toxins A and B. Diarrhea was 76 attributed to COVID-19 and resolved automatically. Two subsequent PCR tests for 77 SARS-CoV-2, performed 24 hours apart were negative and the patient was discharged 78 after 12 days of hospitalization. Two weeks post discharge the patient returned to our clinic for evaluation. The patient 80 was afebrile since her discharge and she only complained for abdominal discomfort. Michalis Liontos: Conceptualization; Data curation Roles/Writing -original draft Andreas Mentis, Flora 154 Zagouri: Data curation Evangelos Terpos: Resources, Writing -review & editing Supervision, Writing -review & editing References COVID-19 Global Pandemic: Options for Management of 161 Gynecologic Cancers Cancer patients in SARS-CoV-2 infection: a nationwide analysis in 163 China. The Lancet Oncology Cancer guidelines during the COVID-19 pandemic. The Lancet Oncology Infections in Cancer Patients with Solid Tumors: A Review. Infectious 167 diseases and therapy Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 169 recovered patient cohort and their implications. medRxiv Lower detection rates of SARS-COV2 antibodies in cancer 172 patients vs healthcare workers after symptomatic COVID-19 Do Patients with Cancer Have a Poorer Prognosis of COVID-19? 174 An Experience in New York City Complex Immune Dysregulation in COVID-19 176 Patients with Severe Respiratory Failure Effective treatment of severe COVID-19 patients with tocilizumab