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Introduction: The COVID-19 pandemic has caused unprecedented crisis in the care of non-Covid patients all across the globe and care for lung cancer patients is no exception Lung Cancer patients are at increased risks of COVID due to increased mortality from dual aggressive pathology in the lungs Our aim was to examine the impact of COVID-19 on lung cancer therapy and factors responsible delay in optimal care during the pandemic Methods: This study included all patients with a diagnosis of lung cancer being treated at our Institute, a tertiary level referral hospital in eastern part of India during on going pandemic Seven developed COVID-19, confirmed by RT-PCR method (Table 1) Results: The mean age of the patients was 49 years All the patients had metastatic lung cancer All males had history of smoking Hypertension was present in only one patient Four patients (57%) died from concomitant COVID-19 at our institution Three patients who recovered from COVID were stable One of them (positive for ROS1) was switched over to Crizotinib and other patient resumed chemotherapy only after he had recovered from COVID-19 Most of the patients acquired COVID-19 infection during the process of evaluatio/chemotherapy and that further delayed the treatment [Formula presented] Conclusion: The results were disappointing because more than half of lung cancer patients died due to COVID-19 The disease course of COVID-19 has been more severe in patients with lung cancers with Chemotherapy There have been delay in resuming treatment among survivors by few weeks Fear of aggressiveness of disease was the key factor for interruption or delay in chemotherapy Other variable factors like stage of cancer, palliative intent of chemotherapy, ECOG status were key determinants for interruption of treatment The decision to temporarily suspend chemotherapy while waiting for recovery from SARS-CoV-2 and then restart, was not easy due to the risk of cancer progression The findings amplify the importance of optimizing of lung cancer care in the context of the COVID-19 prevalence The decisions need to be taken on the basis of individual cases rather than rely on a generalized approach In resource limited country like India diverting the existing resources to an emergency leads to compromise of routine outpatient care, especially patients with chronic illness We need to be flexible in restarting of services guided by local COVID prevalence, while awaiting a definite management plan for COVID-19 Keywords: lung cancer, India, COVID-19, SARS-CoV-2

Introduction: COVID-19 pandemic has led to reconsider the traditional management approach in lung cancer Oral tyrosine kinase inhibitors (TKIs) are being preferred in oncogene addicted advanced non-Small Cell Lung Cancer Methods: A young never-smoker woman presented with left hilar mass with left pleural effusion in February 2020 There was an incidental detection of thrombus in right main and descending pulmonary artery She was diagnosed to have ROS1 rearranged advanced NSCLC with pulmonary embolism She was initiated on conventional chemotherapy with carboplatin and pemetrexed along with anticoagulation After fourth cycle of chemotherapy, although there was clinical improvement attributed to reduction of amount of effusion and disappearance thrombus, RECIST 1 1 criteria suggested the progression of disease in view of appearance of adrenal metastasis Meanwhile, she had a history of high risk exposure with a patient of COVID- 19 in July 2020 Although she was asymptomatic, RT- PCR for SARS-COV2 came out to be positive Results: She remained asymptomatic for next 10 days during hospitalization Then she was started on Crizotinib and was discharged with advice on further follow up Conclusion: Although patients on cancer chemotherapy are at high risk of severe COVID-19 diseases, asymptomatic cases can happen The patients preferably should be shifted to or started on oral TKIs as per available expert recommendations Keywords: ROS1, COVID-19, TKI