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BACKGROUND The COVID-19 pandemic has profoundly affected cancer services. Our objective was to determine the effect of the COVID-19 pandemic on decision making and the resulting outcomes for patients with newly diagnosed or recurrent intracranial tumors. METHODS We performed a multi-centre prospective study of all adult patients discussed in weekly neuro-oncology and skull base MDTs who had a newly diagnosed or recurrent intracranial (excluding pituitary) tumor between 01 April and 31 May 2020. All patients had follow-up data at least 30-days after the index MDT date. Descriptive statistical reporting was used. RESULTS There were 1357 referrals for newly diagnosed or recurrent intracranial tumors across fifteen neuro-oncology centres. Of centres with all intracranial tumors, a change in initial MDT management was reported in 8.6% of cases (n=104/1210). Decisions to change the MDT management plan reduced over time from a peak of 19% referrals at the start of the study to 0% by the end of the study period. Changes in management were reported in 16% (n=75/466) of cases previously recommended for surgery and 28% of cases previously recommended for chemotherapy (n=20/72). The reported SARS-CoV-2 infection rate was similar in surgical and non-surgical patients (2.6% vs. 2.4%, p >0.9). CONCLUSIONS Disruption to neuro-oncology services in the UK caused by the COVID-19 pandemic was most marked in the first month, affecting all diagnoses. Patients considered for chemotherapy were most affected. In those recommended surgical treatment this was successfully completed. Longer-term outcome data will evaluate oncological treatments received by these patients and overall survival.

Background Fingolimod is prescribed in the UK following NICE approval in 2012. In Newcastle, our regional service, high prevalence and subspecialty structures have allowed us to accumulate a large cohort starting fingolimod, with >130 by January 2014. Objectives 1) to audit prescribing against the European license and NICE guidelines. 2) to evaluate the impact on DMT prescribing, staff interaction and relapse treatment. 3) to describe the rate and reasons for discontinuation. Methods To permit adequate follow up, we identified the first 100 from a comprehensive database, collecting data on counselling, eligibility, screening, first-dose monitoring, laboratory and ophthalmological surveillance. We evaluated our use of MRI and documentation of relapse and subsequent DMT changes. Causes of discontinuation were recorded. Results Compliance with EMA advice on risk management was good. Considering eligibility, there was a significant group switching from natalizumab, a circumstance not considered by NICE. Fingolimod was well tolerated, with our few discontinuations related to abnormal bloods, nonspecific symptoms and single cases related to relapse, Ramsay-Hunt syndrome and 2° AV block. Conclusions Our experience is commensurate with expectations from trials. While the demands of the risk management plan are high, we have complied well, reflecting increasing confidence in managing higher risk DMTs.