Overview

The researchers are doing this study to find out whether the study drug hydroxychloroquine can prevent infection with the COVID-19 virus, compared with placebo, in people who are receiving radiation therapy for their cancer. The placebo used in this study is a tablet that looks the same as the study drug and is taken in the same way, but it does not contain any active ingredients.

Eligibility

Inclusion Criteria:

• Age 18
• ECOG 0-3
• For patients who have not started radiation at the time of screening: patients are required to have a plan in place for a minimum of 10 radiation treatments with or without concurrent systemic therapy
• For patients who have already started radiation at the time of screening: patients must complete enrollment such that they are able to receive at least 10 radiation treatments with hydroxychloroquine.
• Disease Site
• Mandatory inclusion criteria:
• No COVID-19 symptoms within 14 days of enrollment:
• (Temp >38C in addition to sore throat, cough, wheezing, chest tightness, shortness of breath, body aches, chills, diarrhea, and anosmia)
• If symptoms are present within 14 days of enrollment, patients with a negative COVID-19 PCR or COVID-19 serology assay are eligible for inclusion.
• No close contact with confirmed COVID-19 person
• Close contact defined as:
• Within 6 feet for prolonged period
• Cohabitating
• Optional laboratory criteria (Recommended if available)
• Negative pre-treatment SARS-CoV-2 rapid antigen test result (within 1 week of enrollment)
• Negative pre-treatment SARS-CoV-2 PCR test result (within 1 week of enrollment) using MSKCC laboratory or outside laboratory assay
• Negative pre-treatment Standard Q COVID-19 IgM/IgG rapid serology result (within 1 week of enrollment)
• Blood serum for SARS-CoV-2 serology tests (being validated by MSKCC)
• Disease site meets following criteria:
• Head and Neck / High-Risk Skin Cancer
• Lung Cancer
• Breast Cancer
• Prostate Cancer
• Central Nervous System Tumors
• Gastrointestinal System Cancer
• Gynecologic cancer
• Other disease sites permitted at PI discretion

Exclusion Criteria:

• Previous positive test for SARS-CoV-2
• Previous positive serology test for SARS-CoV-2
• Recent Chest CT meeting CT exclusion criteria
• Live in a skilled nursing facility with COVID-19 symptoms (Temp >38 C in addition to sore throat, cough, wheezing, chest tightness, shortness of breath, body aches or chills, diarrhea, anosmia)
• Known hypersensitivity to hydroxychloroquine or 4-aminoquinoline derivatives
• Pre-existing retinopathy
• Known chronic kidney disease, stage 4 or 5, or receiving dialysis
• Breast Feeding
• Tamoxifen
• Absolute neutrophil Count <1,000/ml at registration
• Concurrent use of any other quinine derivative
• Antiarrhythmic medications: amiodarone, sotalol, dofetilide, procainamide, quinidine, flecainide
• Glucose-6-phosphate dehydrogenase deficiency
• Pre-treatment corrected QT interval (QTc) 470 milliseconds**
• Prisoners
• Inability to participate
• Psoriasis
• History of suicidal ideation
• CT Criteria for Enrollment Exclusion (Optional - only for patients who received a diagnostic CT as part of standard of care or a thoracic CT as part of radiation simulation): All patients with COVID-19 typical radiographic findings on CT Chest as defined by the RSNA will be excluded. Patients with any NEW COVID-19 indeterminate radiographic findings on CT Chest that are concerning for COVID-19 will be excluded. COVID-19 indeterminate features are permitted if they can be demonstrated as STABLE on prior (>14 calendar days) CT Chest or PET/CT. If no prior comparison is available AND any intermediate or typical feature is present, the patient is not eligible.
• COVID-19 Atypical Features
• Isolated lobar or segmental consolidation without GGO
• Discrete small nodules (centrilobular, "tree-in-bud")
• Lung cavitation
• Smooth interlobular septal thickening with pleural effusion
• COVID-19 Indeterminate Features
• Multifocal, diffuse, perihilar, or unilateral GGO with or without consolidation lacking a specific distribution and are non-rounded or non-peripheral
• Few very small GGO with a non-rounded and non-peripheral distribution
• COVID-19 Typical Features
• Peripheral, bilateral GGO with or without consolidation or visible intralobular lines ("crazy paving")
• Multifocal GGO of rounded morphology with or without consolidation or visible intralobular lines ("crazy paving")
• Reverse Halo sign or other findings of organizing pneumonia ** If pre-treatment QTC can be decreased to <470, the patient can be re-considered for trial.