Systemic treatment of patients with gastrointestinal cancers during the COVID-19 outbreak: COVID-19-adapted recommendations of the National Cancer Institute of Milan

Abstract The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak poses a major challenge in the treatment decision making of cancer patients, who may be at higher risk of developing a severe and deadly SARS-CoV-2 infection compared to the general population. The healthcare emergency is forcing to reshape the daily assessment between risks and benefits expected from the administration of immune-suppressive and potentially toxic treatments. To guide our clinical decisions at the National Cancer Institute of Milan (Lombardy region, the epicentre of the outbreak in Italy), we formulated Coronavirus-adapted Institutional recommendations for the systemic treatment of patients with gastrointestinal cancers. Here we describe how our daily clinical practice has changed due to the pandemic outbreak, with the aim of providing useful suggestions for physicians that are facing the same challenges worldwide.