In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
Acknowledging that there is no time for good trials yet in this setting
Question Created by Elie Chalhoub
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At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect there will be a shortage of this drug for patients with autoimmune diseases who need it, so at this time better left for use in patients who already have COVID-19. These patients should be included in protocols with careful measurement of outcomes so appropriate evidence of risks and benefits can be established. In this setting, use in cancer patients would be appropriate.
Chloroquine and hydroxychloroquine are generally very safe, especially when used in short periods of time, but they have interactions with other drugs, and this needs to be considered when they are prescribed.
Stay safe!
Thank you both for your comments. I understand that it is always good to have “good data” with many patients, controls, and randomization. And I certainly understand the great benefits in RA, SLE, etc. My daughter has had psoriasis since age 17(21y), and has been through the full gamut of treatments (U-Penn derm). For the past 7 or 8 yrs she has been on a few different immune meds (Humira, Embrel, etc). She even worked in the pediatric PICU at CHOP—dealing with a lot of respiratory infections; fortunately she weathered a number of storms.
Presently, she works in a medonc unit, essentially/fortunately isolated in triage. From what I see, HCQ works best very early, preventing the virus from penetrating the wall of one of the two different alveolar cells. With all due respect to the patients currently on HCQ, should she develop the classic sx of COVID, I would push extremely hard to get her started ASAP (BTW, she has taken it B4 on a trip to S. Africa; as well as Zpak)!! Rhetorically—if it works for RA, would it perhaps work on slowing down PA from developing (she has been experiencing some increasing hand/wrist pains over the past year)?
Anyhow, there has been a lot of dishonesty about COVID since last year. Our huge healthcare bureaucratic system has not been adequately preparing for many years; and, as it tends to be our nature in this great country, we tend to rationalize—sometimes too long—to our detriment. But we do have phenomenal technology, which at times seduces us into complacency. Be well, stay well.
Actually, there is some data, not great though, that hydroxychloroquine may exacerbate psoriasis and make it pustular. Not great data as I say, but in general we stay away from prescribing it in psoriasis for that reason.