Yarrarapu, Siva Naga S.

Introduction In the unprecedented era of COVID-19, ongoing research and evolution of evidence has led to ever-changing guidelines for clinical monitoring and therapeutic options. Formulating treatment protocols requires the understanding and application of the evolving research. Objective The primary objective of this study is to present a systematic evidence-based approach to synthesize the necessary data in order to optimize the management of COVID-19. Methods At Mayo Clinic Florida, we developed a multidisciplinary centralized COVID Treatment Review Panel (TRP) of expert pulmonologists, intensivists, infectious disease specialists, anesthesiologists, hematologists, rheumatologists, and hospitalists that in real-time reviews the latest evidence in peer-reviewed journals, the available clinical trials, and help guide the rapid application of therapeutics or interventions to the patient and the bedside provider. Results/Conclusions The multi-disciplinary team approach of synthesizing clinical data and coordinating care is effective in responding to rapidly evolving and changing evidence. Systematic data collection and evidence-based treatment algorithms enable physicians to rapidly translate the current literature to clinical practice, and improve care and outcomes of patients.

Oesophageal cancer is categorised among the most fatal cancers across the world with a mortality ranking of sixth position. Chemotherapy with FOLFOX—a regimen of fluorouracil, leucovorin, and oxaliplatin—has been approved in the treatment of oesophageal cancer owing to its lower toxicity compared with the previous regimens. We report the first case of a patient with oesophageal cancer metastatic to the hyoid presenting with sudden-onset shortness of breath and anterior neck swelling secondary to treatment with FOLFOX-6. CT was notable for subglottic soft-tissue swelling and cystic necrosis of the hyoid bone tumour, and the patient subsequently required placement of a definitive airway via tracheostomy. This case illustrates the importance of anticipating the need for pre-emptive tracheostomy in patients with hyoid bone tumours receiving treatment with FOLFOX.

Immune checkpoint inhibitors have revolutionised cancer therapy in the past decade. Although they have been indicated to treat a diverse range of malignant neoplasms, they are also associated with various immune-related adverse effects. We report the case of a 74-year-old man with a history of urothelial carcinoma who had atezolizumab-induced myocarditis and myositis resulting in acute hypercapnic respiratory failure, despite the discontinuation of atezolizumab and aggressive treatment with corticosteroids. This case highlights the importance of a multidisciplinary approach for early diagnosis and treatment of immune-related adverse events. Physicians must be aware of the risks associated with immune checkpoint inhibitors and have a basic knowledge regarding their management.